Provider Demographics
NPI:1841761319
Name:MUSTELIER, CARMEN (CCC-SLP)
Entity Type:Individual
Prefix:
First Name:CARMEN
Middle Name:
Last Name:MUSTELIER
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3445 SW 92ND AVE
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33165-4127
Mailing Address - Country:US
Mailing Address - Phone:718-404-7348
Mailing Address - Fax:
Practice Address - Street 1:3445 SW 92ND AVE
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33165-4127
Practice Address - Country:US
Practice Address - Phone:718-404-7348
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-12-10
Last Update Date:2023-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA20911235Z00000X
GASLP010295235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLSA20911OtherFL LICENSE
GASLP010295OtherGA STATE