Provider Demographics
NPI:1407853591
Name:LEVY, JOAN I (CCC-SLP)
Entity Type:Individual
Prefix:
First Name:JOAN
Middle Name:I
Last Name:LEVY
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10973 NW 64TH DR
Mailing Address - Street 2:
Mailing Address - City:PARKLAND
Mailing Address - State:FL
Mailing Address - Zip Code:33076-3738
Mailing Address - Country:US
Mailing Address - Phone:954-529-7300
Mailing Address - Fax:754-529-8998
Practice Address - Street 1:10973 NW 64TH DR
Practice Address - Street 2:
Practice Address - City:PARKLAND
Practice Address - State:FL
Practice Address - Zip Code:33076-3738
Practice Address - Country:US
Practice Address - Phone:954-529-7300
Practice Address - Fax:754-529-8998
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-05
Last Update Date:2017-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA5588235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL889195800Medicaid
FLSA5588OtherSTATE OF FLORIDA LICENSE