Provider Demographics
NPI:1427365261
Name:IZQUIERDO, MELISSA KRISTINA (MS CCC SLP)
Entity Type:Individual
Prefix:MRS
First Name:MELISSA
Middle Name:KRISTINA
Last Name:IZQUIERDO
Suffix:
Gender:F
Credentials:MS CCC SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12852 SW 46TH TER
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33175-4620
Mailing Address - Country:US
Mailing Address - Phone:305-553-9884
Mailing Address - Fax:
Practice Address - Street 1:2955 CORAL WAY
Practice Address - Street 2:
Practice Address - City:CORAL GABLES
Practice Address - State:FL
Practice Address - Zip Code:33145-3205
Practice Address - Country:US
Practice Address - Phone:305-444-9259
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-31
Last Update Date:2010-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA 10613235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist