Provider Demographics
NPI:1376165738
Name:GARCIA, RAQUEL (MS, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:RAQUEL
Middle Name:
Last Name:GARCIA
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 1:14050 NESTING WAY APT A
Mailing Address - Street 2:
Mailing Address - City:DELRAY BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33484-8697
Mailing Address - Country:US
Mailing Address - Phone:973-220-1898
Mailing Address - Fax:
Practice Address - Street 1:14050 NESTING WAY APT A
Practice Address - Street 2:
Practice Address - City:DELRAY BEACH
Practice Address - State:FL
Practice Address - Zip Code:33484-8697
Practice Address - Country:US
Practice Address - Phone:973-220-1898
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-05-08
Last Update Date:2020-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ41YS00835400235Z00000X
FLSA17261235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist