Provider Demographics
NPI:1962029496
Name:SCHUTTE-POWELL, GLORIA SORAYA (MS CCC-SLP)
Entity Type:Individual
Prefix:
First Name:GLORIA
Middle Name:SORAYA
Last Name:SCHUTTE-POWELL
Suffix:
Gender:F
Credentials:MS CCC-SLP
Other - Prefix:
Other - First Name:GLORIA
Other - Middle Name:SORAYA JERROLDINE
Other - Last Name:POWELL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:13337 FOSSICK RD
Mailing Address - Street 2:
Mailing Address - City:WINDERMERE
Mailing Address - State:FL
Mailing Address - Zip Code:34786-7310
Mailing Address - Country:US
Mailing Address - Phone:407-590-8334
Mailing Address - Fax:
Practice Address - Street 1:13337 FOSSICK RD
Practice Address - Street 2:
Practice Address - City:WINDERMERE
Practice Address - State:FL
Practice Address - Zip Code:34786-7310
Practice Address - Country:US
Practice Address - Phone:407-590-8334
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-30
Last Update Date:2020-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CASP29990235Z00000X
TX116587235Z00000X
FLSA5950235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist