Provider Demographics
NPI:1235885468
Name:MERCADO HERNANDEZ, IGMARIE (CCC-SLP)
Entity Type:Individual
Prefix:
First Name:IGMARIE
Middle Name:
Last Name:MERCADO HERNANDEZ
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3961 SW GREENWOOD WAY APT E
Mailing Address - Street 2:
Mailing Address - City:PALM CITY
Mailing Address - State:FL
Mailing Address - Zip Code:34990-4646
Mailing Address - Country:US
Mailing Address - Phone:787-515-0605
Mailing Address - Fax:
Practice Address - Street 1:3961 SW GREENWOOD WAY APT E
Practice Address - Street 2:
Practice Address - City:PALM CITY
Practice Address - State:FL
Practice Address - Zip Code:34990-4646
Practice Address - Country:US
Practice Address - Phone:787-515-0605
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-25
Last Update Date:2023-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL10213235Z00000X
FLSA20776235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist