Provider Demographics
NPI:1396390209
Name:AGUERO, MARLENE
Entity Type:Individual
Prefix:MISS
First Name:MARLENE
Middle Name:
Last Name:AGUERO
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 1:5401 COLLINS AVE STE CU12
Mailing Address - Street 2:
Mailing Address - City:MIAMI BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33140-5525
Mailing Address - Country:US
Mailing Address - Phone:305-397-8993
Mailing Address - Fax:305-763-8029
Practice Address - Street 1:5401 COLLINS AVE
Practice Address - Street 2:
Practice Address - City:MIAMI BEACH
Practice Address - State:FL
Practice Address - Zip Code:33140-2573
Practice Address - Country:US
Practice Address - Phone:305-763-8029
Practice Address - Fax:305-763-8029
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-07
Last Update Date:2019-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SZ9145235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty