Provider Demographics
NPI:1710343827
Name:IRIZARRY, KEREN DAMARIS (MS)
Entity Type:Individual
Prefix:
First Name:KEREN
Middle Name:DAMARIS
Last Name:IRIZARRY
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:501 E MAIN ST STE 4
Mailing Address - Street 2:
Mailing Address - City:HAINES CITY
Mailing Address - State:FL
Mailing Address - Zip Code:33844-4244
Mailing Address - Country:US
Mailing Address - Phone:074-529-6514
Mailing Address - Fax:352-717-6829
Practice Address - Street 1:501 E MAIN ST STE 4
Practice Address - Street 2:
Practice Address - City:HAINES CITY
Practice Address - State:FL
Practice Address - Zip Code:33844-4244
Practice Address - Country:US
Practice Address - Phone:407-452-9651
Practice Address - Fax:352-717-6829
Is Sole Proprietor?:No
Enumeration Date:2016-01-05
Last Update Date:2022-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
235Z00000X
FLSZ 7201235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist