Provider Demographics
NPI:1023539558
Name:COSTA RIBEIRO, CAROLINA (MA CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:CAROLINA
Middle Name:
Last Name:COSTA RIBEIRO
Suffix:
Gender:F
Credentials:MA CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13801 BELLES LN
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32826-4939
Mailing Address - Country:US
Mailing Address - Phone:497-267-6672
Mailing Address - Fax:
Practice Address - Street 1:1858 N ALAFAYA TRL STE 207
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32826-4754
Practice Address - Country:US
Practice Address - Phone:407-900-5313
Practice Address - Fax:888-972-5443
Is Sole Proprietor?:Yes
Enumeration Date:2017-07-06
Last Update Date:2017-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA12838235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty