Provider Demographics
NPI:1942584891
Name:THOMPSON, SERENE
Entity Type:Individual
Prefix:
First Name:SERENE
Middle Name:
Last Name:THOMPSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17911 NW 68TH AVE
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33015-3959
Mailing Address - Country:US
Mailing Address - Phone:954-701-3562
Mailing Address - Fax:
Practice Address - Street 1:17911 NW 68TH AVE
Practice Address - Street 2:APT P-202
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33015-3959
Practice Address - Country:US
Practice Address - Phone:954-701-3562
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-10
Last Update Date:2011-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSZ5197235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist