Provider Demographics
NPI:1972639672
Name:FREIRE, MIRKA (CCC-SLP)
Entity Type:Individual
Prefix:
First Name:MIRKA
Middle Name:
Last Name:FREIRE
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 1:9400 SW 31ST TER
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33165-3117
Mailing Address - Country:US
Mailing Address - Phone:786-586-4856
Mailing Address - Fax:305-558-4649
Practice Address - Street 1:18191 NW 68TH AVE
Practice Address - Street 2:SUITE 216
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33015-3996
Practice Address - Country:US
Practice Address - Phone:305-558-4646
Practice Address - Fax:305-558-4649
Is Sole Proprietor?:No
Enumeration Date:2007-02-26
Last Update Date:2015-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA8455235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL890599100Medicaid