Provider Demographics
NPI:1578991998
Name:RZYMEK, MIA VICTORIA (MA,CCC-SLP)
Entity Type:Individual
Prefix:
First Name:MIA
Middle Name:VICTORIA
Last Name:RZYMEK
Suffix:
Gender:F
Credentials:MA,CCC-SLP
Other - Prefix:
Other - First Name:MIA
Other - Middle Name:VICTORIA
Other - Last Name:D'ERRICO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:8801 J M KEYNES DR
Mailing Address - Street 2:SUITE 350
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28262-8436
Mailing Address - Country:US
Mailing Address - Phone:704-423-9449
Mailing Address - Fax:
Practice Address - Street 1:8801 J M KEYNES DR
Practice Address - Street 2:SUITE 350
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28262-8436
Practice Address - Country:US
Practice Address - Phone:704-423-9449
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-10-22
Last Update Date:2017-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA12132235Z00000X
NC11070235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist