Provider Demographics
NPI:1083859052
Name:WAITE, DENISE TROILO- (MS, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:DENISE
Middle Name:TROILO-
Last Name:WAITE
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1134 TOPLIFF CIR NE
Mailing Address - Street 2:
Mailing Address - City:PALM BAY
Mailing Address - State:FL
Mailing Address - Zip Code:32907-2201
Mailing Address - Country:US
Mailing Address - Phone:321-501-0158
Mailing Address - Fax:
Practice Address - Street 1:1134 TOPLIFF CIR NE
Practice Address - Street 2:
Practice Address - City:PALM BAY
Practice Address - State:FL
Practice Address - Zip Code:32907-2201
Practice Address - Country:US
Practice Address - Phone:321-501-0158
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-04
Last Update Date:2015-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA6657235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist