Provider Demographics
NPI:1376077362
Name:TRONCOSO, DELIA M (MS, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:DELIA
Middle Name:M
Last Name:TRONCOSO
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 1:3024 PATRICK PL
Mailing Address - Street 2:
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33759-1439
Mailing Address - Country:US
Mailing Address - Phone:727-687-4942
Mailing Address - Fax:
Practice Address - Street 1:3190 N MCMULLEN BOOTH RD
Practice Address - Street 2:SUITE 100
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33761-2013
Practice Address - Country:US
Practice Address - Phone:727-791-1368
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-04-17
Last Update Date:2017-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA3130235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist