Provider Demographics
NPI:1093173197
Name:DAVILA, JACQUELINE LAUREL
Entity Type:Individual
Prefix:MS
First Name:JACQUELINE
Middle Name:LAUREL
Last Name:DAVILA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1759 SW 138 AVE
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33175
Mailing Address - Country:US
Mailing Address - Phone:305-496-5220
Mailing Address - Fax:
Practice Address - Street 1:27571 S DIXIE HWY
Practice Address - Street 2:
Practice Address - City:NARANJA
Practice Address - State:FL
Practice Address - Zip Code:33032-8297
Practice Address - Country:US
Practice Address - Phone:786-282-4392
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-02-03
Last Update Date:2016-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL27472355S0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant