Provider Demographics
NPI:1336641620
Name:CONKLIN, DENISE OLIVEIRA
Entity Type:Individual
Prefix:MRS
First Name:DENISE
Middle Name:OLIVEIRA
Last Name:CONKLIN
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 1:15151 HARROWGATE WAY
Mailing Address - Street 2:
Mailing Address - City:WINTER GARDEN
Mailing Address - State:FL
Mailing Address - Zip Code:34787-4702
Mailing Address - Country:US
Mailing Address - Phone:407-405-3731
Mailing Address - Fax:
Practice Address - Street 1:15151 HARROWGATE WAY
Practice Address - Street 2:
Practice Address - City:WINTER GARDEN
Practice Address - State:FL
Practice Address - Zip Code:34787-4702
Practice Address - Country:US
Practice Address - Phone:407-405-3731
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-02
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSI3408235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLSI3408OtherSPEECH THERAPIST ASSISTANT