Provider Demographics
NPI:1043519614
Name:SUAREZ, JUAN (CCC-SLP)
Entity Type:Individual
Prefix:MR
First Name:JUAN
Middle Name:
Last Name:SUAREZ
Suffix:
Gender:M
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5120 BAYOU BLVD
Mailing Address - Street 2:SUITE 6
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32503-2193
Mailing Address - Country:US
Mailing Address - Phone:413-246-1445
Mailing Address - Fax:
Practice Address - Street 1:5120 BAYOU BLVD
Practice Address - Street 2:SUITE 6
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32503-2193
Practice Address - Country:US
Practice Address - Phone:413-246-1445
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-22
Last Update Date:2016-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA-9434235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist