Provider Demographics
NPI:1235361858
Name:PEREZ, BLANCA A (MS, CCC-SLP)
Entity Type:Individual
Prefix:MS
First Name:BLANCA
Middle Name:A
Last Name:PEREZ
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:BLANCA
Other - Middle Name:A
Other - Last Name:PEREZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, CCC-SLP
Mailing Address - Street 1:2220 UNDERWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:SAINT CLOUD
Mailing Address - State:FL
Mailing Address - Zip Code:34771-7707
Mailing Address - Country:US
Mailing Address - Phone:407-405-2352
Mailing Address - Fax:407-515-6519
Practice Address - Street 1:2220 UNDERWOOD AVE
Practice Address - Street 2:
Practice Address - City:SAINT CLOUD
Practice Address - State:FL
Practice Address - Zip Code:34771-7707
Practice Address - Country:US
Practice Address - Phone:407-405-2352
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-14
Last Update Date:2024-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA8035235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist