Provider Demographics
NPI:1457499097
Name:MERLO-GOMEZ, MASSIEL (MS, CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:MASSIEL
Middle Name:
Last Name:MERLO-GOMEZ
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 1:13068 NW 19TH ST
Mailing Address - Street 2:
Mailing Address - City:PEMBROKE PINES
Mailing Address - State:FL
Mailing Address - Zip Code:33028-2523
Mailing Address - Country:US
Mailing Address - Phone:954-437-2317
Mailing Address - Fax:
Practice Address - Street 1:13068 NW 19TH ST
Practice Address - Street 2:
Practice Address - City:PEMBROKE PINES
Practice Address - State:FL
Practice Address - Zip Code:33028-2523
Practice Address - Country:US
Practice Address - Phone:954-437-2317
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-04
Last Update Date:2009-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA5789235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist