Provider Demographics
NPI:1790099851
Name:FARRELL-LATOUR, RAQUAEL ANGELA (MS, CCC-SLP)
Entity Type:Individual
Prefix:MS
First Name:RAQUAEL
Middle Name:ANGELA
Last Name:FARRELL-LATOUR
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 1:9746 NW 18TH ST
Mailing Address - Street 2:
Mailing Address - City:CORAL SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:33071-5824
Mailing Address - Country:US
Mailing Address - Phone:954-234-0295
Mailing Address - Fax:954-234-0295
Practice Address - Street 1:9746 NW 18TH ST
Practice Address - Street 2:
Practice Address - City:CORAL SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:33071-5824
Practice Address - Country:US
Practice Address - Phone:954-234-0295
Practice Address - Fax:954-234-0295
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-31
Last Update Date:2023-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA8596235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist