Provider Demographics
NPI:1891087391
Name:LITVACK, VENITA MARIE (MA, CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:VENITA
Middle Name:MARIE
Last Name:LITVACK
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:MS
Other - First Name:VENITA
Other - Middle Name:MARIE
Other - Last Name:FREIA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA, CF-SLP
Mailing Address - Street 1:3335 N UNIVERSITY DR
Mailing Address - Street 2:SUITE 5
Mailing Address - City:HOLLYWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:33024-2200
Mailing Address - Country:US
Mailing Address - Phone:954-442-9422
Mailing Address - Fax:954-442-9150
Practice Address - Street 1:3335 N UNIVERSITY DR
Practice Address - Street 2:SUITE 5
Practice Address - City:HOLLYWOOD
Practice Address - State:FL
Practice Address - Zip Code:33024-2200
Practice Address - Country:US
Practice Address - Phone:954-442-9422
Practice Address - Fax:954-442-9150
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-03
Last Update Date:2015-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA14270235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLSZ6977OtherDEPARTMENT OF HEALTH
FL884449600Medicaid
FLSA 14270OtherDEPARTMENT OF HEALTH