Provider Demographics
NPI:1518103415
Name:SOTO, MILDRED (MA CCC SLP)
Entity Type:Individual
Prefix:
First Name:MILDRED
Middle Name:
Last Name:SOTO
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 1:2215 CRUGER AVENUE
Mailing Address - Street 2:APT. 5G
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10467
Mailing Address - Country:US
Mailing Address - Phone:917-406-2997
Mailing Address - Fax:
Practice Address - Street 1:2215 CRUGER AVE
Practice Address - Street 2:APT. 5G
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10467-9407
Practice Address - Country:US
Practice Address - Phone:917-406-2997
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-23
Last Update Date:2008-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY010786-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist