Provider Demographics
NPI:1063644573
Name:NAVARRO, LOURDES D (SLPA, ITDS)
Entity Type:Individual
Prefix:MS
First Name:LOURDES
Middle Name:D
Last Name:NAVARRO
Suffix:
Gender:F
Credentials:SLPA, ITDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1478 W 44TH TER
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33012-7675
Mailing Address - Country:US
Mailing Address - Phone:786-416-3267
Mailing Address - Fax:305-556-3457
Practice Address - Street 1:327 W 9TH ST
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33010-3853
Practice Address - Country:US
Practice Address - Phone:305-863-2233
Practice Address - Fax:305-863-3296
Is Sole Proprietor?:No
Enumeration Date:2009-08-17
Last Update Date:2009-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL222Q00000X
FLSI15102355S0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist
No2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant