Provider Demographics
NPI:1891301271
Name:ALICEA, CARLOS RENE JR (SLP-A)
Entity Type:Individual
Prefix:MR
First Name:CARLOS
Middle Name:RENE
Last Name:ALICEA
Suffix:JR
Gender:M
Credentials:SLP-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10349 CYPRESS TRAIL DR
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32825-5043
Mailing Address - Country:US
Mailing Address - Phone:786-436-0278
Mailing Address - Fax:
Practice Address - Street 1:13574 VILLAGE PARK DR STE SUITE205
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32837-7689
Practice Address - Country:US
Practice Address - Phone:407-789-7777
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-21
Last Update Date:2020-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL45122355S0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant