Provider Demographics
NPI:1619217783
Name:DESOUSA, RHONDA ANN (MED CCC/SLP)
Entity Type:Individual
Prefix:MRS
First Name:RHONDA
Middle Name:ANN
Last Name:DESOUSA
Suffix:
Gender:F
Credentials:MED CCC/SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7397 LANGSTON CT
Mailing Address - Street 2:
Mailing Address - City:LAKE WORTH
Mailing Address - State:FL
Mailing Address - Zip Code:33467-7744
Mailing Address - Country:US
Mailing Address - Phone:561-968-7424
Mailing Address - Fax:
Practice Address - Street 1:7397 LANGSTON CT
Practice Address - Street 2:
Practice Address - City:LAKE WORTH
Practice Address - State:FL
Practice Address - Zip Code:33467-7744
Practice Address - Country:US
Practice Address - Phone:561-968-7424
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-02-26
Last Update Date:2013-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA 2505235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist