Provider Demographics
NPI:1710293063
Name:MORALES, RHONDA BRYANT (MS CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:RHONDA
Middle Name:BRYANT
Last Name:MORALES
Suffix:
Gender:F
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 1:3850 SW CHAFFIN ST
Mailing Address - Street 2:
Mailing Address - City:PORT ST LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34953-5304
Mailing Address - Country:US
Mailing Address - Phone:561-718-6110
Mailing Address - Fax:772-340-4879
Practice Address - Street 1:3850 SW CHAFFIN ST
Practice Address - Street 2:
Practice Address - City:PORT ST LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34953-5304
Practice Address - Country:US
Practice Address - Phone:561-718-6110
Practice Address - Fax:772-340-4879
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-24
Last Update Date:2010-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA8414235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist