Provider Demographics
NPI:1083191217
Name:TAGGART, MONICA BLANCO (AUD)
Entity Type:Individual
Prefix:
First Name:MONICA
Middle Name:BLANCO
Last Name:TAGGART
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9900 SW 107TH AVE STE 202
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33176-2809
Mailing Address - Country:US
Mailing Address - Phone:053-595-1530
Mailing Address - Fax:
Practice Address - Street 1:9900 SW 107TH AVE STE 202
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33176-2809
Practice Address - Country:US
Practice Address - Phone:305-595-1530
Practice Address - Fax:305-595-1574
Is Sole Proprietor?:No
Enumeration Date:2018-07-20
Last Update Date:2021-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAY2196231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLAY2196OtherLICENSE