Provider Demographics
NPI:1528218013
Name:RA, JIHYE
Entity Type:Individual
Prefix:
First Name:JIHYE
Middle Name:
Last Name:RA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7349 BRIGHTLAND ST
Mailing Address - Street 2:
Mailing Address - City:WINDERMERE
Mailing Address - State:FL
Mailing Address - Zip Code:34786-5599
Mailing Address - Country:US
Mailing Address - Phone:407-312-8215
Mailing Address - Fax:
Practice Address - Street 1:7349 BRIGHTLAND ST
Practice Address - Street 2:
Practice Address - City:WINDERMERE
Practice Address - State:FL
Practice Address - Zip Code:34786-5599
Practice Address - Country:US
Practice Address - Phone:407-312-8215
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-09-22
Last Update Date:2013-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASL009269235Z00000X
FLSA9956235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PASL009269OtherSTATE LICENSE
FLSA9956OtherSPEECH AND LANGUAGE PATHOLOGIST