Provider Demographics
NPI:1649588856
Name:PEREZ, MADELAINE (SLP)
Entity Type:Individual
Prefix:MRS
First Name:MADELAINE
Middle Name:
Last Name:PEREZ
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2238 W 74 ST
Mailing Address - Street 2:101
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33016
Mailing Address - Country:US
Mailing Address - Phone:305-494-9463
Mailing Address - Fax:
Practice Address - Street 1:2238 W 74TH ST
Practice Address - Street 2:101
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33016-6858
Practice Address - Country:US
Practice Address - Phone:305-494-9463
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-09-22
Last Update Date:2015-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSZ 6751235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL014060600Medicaid