Provider Demographics
NPI:1407286545
Name:PHILIPPE-RATWAY, STEPHANE (MMS,CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:STEPHANE
Middle Name:
Last Name:PHILIPPE-RATWAY
Suffix:
Gender:F
Credentials:MMS,CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11200 SW 129TH CT
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33186-4747
Mailing Address - Country:US
Mailing Address - Phone:678-665-1773
Mailing Address - Fax:
Practice Address - Street 1:888 NW 27TH AVE STE 5
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33125-3000
Practice Address - Country:US
Practice Address - Phone:786-431-1133
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-26
Last Update Date:2013-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA12644235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL001701000Medicaid