Provider Demographics
NPI:1568770113
Name:VENEZIA, ROBERT (MS,CCC,SLP)
Entity Type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:
Last Name:VENEZIA
Suffix:
Gender:M
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 1:1918 19TH WAY
Mailing Address - Street 2:
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33407-6625
Mailing Address - Country:US
Mailing Address - Phone:561-313-8120
Mailing Address - Fax:
Practice Address - Street 1:1918 19TH WAY
Practice Address - Street 2:
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33407-6625
Practice Address - Country:US
Practice Address - Phone:561-313-8120
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-09-16
Last Update Date:2014-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RISLP00145235Z00000X
FLSA11166235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist