Provider Demographics
NPI:1003156845
Name:LUNA, DENISE ELAINE (MS,CCC)
Entity Type:Individual
Prefix:MRS
First Name:DENISE
Middle Name:ELAINE
Last Name:LUNA
Suffix:
Gender:F
Credentials:MS,CCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1346 CORDOVA AVE
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33901-6633
Mailing Address - Country:US
Mailing Address - Phone:239-994-6062
Mailing Address - Fax:
Practice Address - Street 1:1346 CORDOVA AVE
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33901-6633
Practice Address - Country:US
Practice Address - Phone:239-994-6062
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-02-14
Last Update Date:2013-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA1188235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist