Provider Demographics
NPI:1679686968
Name:HIGGINS, MATILDA CLAIRE (MA CCC-SLP)
Entity Type:Individual
Prefix:
First Name:MATILDA
Middle Name:CLAIRE
Last Name:HIGGINS
Suffix:
Gender:F
Credentials:MA CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:534 101ST AVE N
Mailing Address - Street 2:
Mailing Address - City:SAINT PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33702-2221
Mailing Address - Country:US
Mailing Address - Phone:727-289-5319
Mailing Address - Fax:
Practice Address - Street 1:534 101ST AVE N
Practice Address - Street 2:
Practice Address - City:SAINT PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33702-2221
Practice Address - Country:US
Practice Address - Phone:727-289-5319
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-17
Last Update Date:2009-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA8071235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLSA8071OtherSTATE LICENSE NUMBER
FL890612200Medicaid