Provider Demographics
NPI:1972744316
Name:PAPILLON, MITZI JUNIA (MS, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:MITZI
Middle Name:JUNIA
Last Name:PAPILLON
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:10211 PINES BLVD # 212
Mailing Address - Street 2:
Mailing Address - City:PEMBROKE PINES
Mailing Address - State:FL
Mailing Address - Zip Code:33026-6003
Mailing Address - Country:US
Mailing Address - Phone:786-203-5848
Mailing Address - Fax:
Practice Address - Street 1:10211 PINES BLVD # 212
Practice Address - Street 2:
Practice Address - City:PEMBROKE PINES
Practice Address - State:FL
Practice Address - Zip Code:33026-6003
Practice Address - Country:US
Practice Address - Phone:786-203-5848
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-16
Last Update Date:2014-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA9461235Z00000X, 222Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
No222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist