Provider Demographics
NPI:1053508895
Name:LEON, BEATRIZ (MA, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:BEATRIZ
Middle Name:
Last Name:LEON
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 1:655 W FLAGLER ST
Mailing Address - Street 2:#204
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33130-1223
Mailing Address - Country:US
Mailing Address - Phone:305-742-1118
Mailing Address - Fax:305-648-1049
Practice Address - Street 1:655 W FLAGLER ST
Practice Address - Street 2:#204
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33130-1223
Practice Address - Country:US
Practice Address - Phone:305-742-1118
Practice Address - Fax:305-648-1049
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-25
Last Update Date:2013-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA 7836235Z00000X, 222Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
No222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL892511900Medicaid
FL006713700Medicaid