Provider Demographics
NPI:1003941162
Name:ACKERMAN, WALESKA M (MS, CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:WALESKA
Middle Name:M
Last Name:ACKERMAN
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1380 N KROME AVE
Mailing Address - Street 2:SUITE #110
Mailing Address - City:FLORIDA CITY
Mailing Address - State:FL
Mailing Address - Zip Code:33034-2406
Mailing Address - Country:US
Mailing Address - Phone:305-247-4464
Mailing Address - Fax:
Practice Address - Street 1:1380 N KROME AVE
Practice Address - Street 2:SUITE #110
Practice Address - City:FLORIDA CITY
Practice Address - State:FL
Practice Address - Zip Code:33034-2406
Practice Address - Country:US
Practice Address - Phone:305-247-4464
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-22
Last Update Date:2014-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA 8872235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL8908401-00Medicaid