Provider Demographics
NPI:1376878587
Name:SANTIAGO, LYMARIS (SLP)
Entity Type:Individual
Prefix:MRS
First Name:LYMARIS
Middle Name:
Last Name:SANTIAGO
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1045 CLUB SYLVAN DR
Mailing Address - Street 2:APT. C
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32825-6023
Mailing Address - Country:US
Mailing Address - Phone:407-615-5647
Mailing Address - Fax:
Practice Address - Street 1:1045 CLUB SYLVAN DR
Practice Address - Street 2:APT. C
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32825-6023
Practice Address - Country:US
Practice Address - Phone:407-615-5647
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-05
Last Update Date:2009-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA10170235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist