Provider Demographics
NPI:1417256769
Name:PARTELOW, XYMENA OLENE (MA CCC-SLP)
Entity Type:Individual
Prefix:
First Name:XYMENA
Middle Name:OLENE
Last Name:PARTELOW
Suffix:
Gender:F
Credentials:MA CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:120 CHARLES ST
Mailing Address - Street 2:
Mailing Address - City:EDGEWATER
Mailing Address - State:FL
Mailing Address - Zip Code:32141-7308
Mailing Address - Country:US
Mailing Address - Phone:386-793-8120
Mailing Address - Fax:386-446-7777
Practice Address - Street 1:120 CHARLES ST
Practice Address - Street 2:
Practice Address - City:EDGEWATER
Practice Address - State:FL
Practice Address - Zip Code:32141-7308
Practice Address - Country:US
Practice Address - Phone:386-793-8120
Practice Address - Fax:386-446-7777
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-24
Last Update Date:2011-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA10891235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLSA10891OtherFL STATE LICENSE