Provider Demographics
NPI:1447400585
Name:WILENSKY ROTBART, DEBRA JILL (SLP)
Entity Type:Individual
Prefix:MRS
First Name:DEBRA
Middle Name:JILL
Last Name:WILENSKY ROTBART
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2124 NE 123RD ST STE 206
Mailing Address - Street 2:
Mailing Address - City:NORTH MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33181-2939
Mailing Address - Country:US
Mailing Address - Phone:305-895-0444
Mailing Address - Fax:305-895-0490
Practice Address - Street 1:2124 NE 123RD ST STE 206
Practice Address - Street 2:
Practice Address - City:NORTH MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33181-2939
Practice Address - Country:US
Practice Address - Phone:305-895-0444
Practice Address - Fax:305-895-0490
Is Sole Proprietor?:No
Enumeration Date:2008-09-25
Last Update Date:2008-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA 3590235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist