Provider Demographics
NPI:1497116222
Name:VAN DER PLAS, ARIADNA CRISTINA (MA CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:ARIADNA
Middle Name:CRISTINA
Last Name:VAN DER PLAS
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 1:19185 SE SOUTHGATE DR
Mailing Address - Street 2:
Mailing Address - City:TEQUESTA
Mailing Address - State:FL
Mailing Address - Zip Code:33469-1658
Mailing Address - Country:US
Mailing Address - Phone:954-701-1330
Mailing Address - Fax:
Practice Address - Street 1:12785 FOREST HILL BLVD
Practice Address - Street 2:SUITE 8G
Practice Address - City:WELLINGTON
Practice Address - State:FL
Practice Address - Zip Code:33414-4777
Practice Address - Country:US
Practice Address - Phone:954-701-1330
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-03-07
Last Update Date:2016-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA14065235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist