MEDICARE: KATHERINE SOTO-DARDIZ M.A. CCC-SLP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	235Z00000X	Speech-Language Pathologist	SA6509	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1649308487
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KATHERINE SOTO-DARDIZ M.A. CCC-SLP

Provider Business Mailing Address
First Line	:	10813 LEADER LN
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32825-7221
Country	:	US
Telephone Number	:	407-384-1919
Fax Number	:	407-384-1919

Provider Business Practice Location Address
First Line	:	10813 LEADER LN
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32825-7221
Country	:	US
Telephone Number	:	407-384-1919
Fax Number	:	407-384-1919

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/01/2007
Last Update Date	:	01/24/2011

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