Provider Demographics
NPI:1013463413
Name:KIRATZIS, EDITH E (MS CF-SLP)
Entity type:Individual
Prefix:
First Name:EDITH
Middle Name:E
Last Name:KIRATZIS
Suffix:
Gender:F
Credentials:MS CF-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1017 SUMMERBROOKE DR
Mailing Address - Street 2:
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32312-6731
Mailing Address - Country:US
Mailing Address - Phone:814-360-6184
Mailing Address - Fax:
Practice Address - Street 1:1017 SUMMERBROOKE DR
Practice Address - Street 2:
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32312-6731
Practice Address - Country:US
Practice Address - Phone:814-360-6184
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-27
Last Update Date:2016-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSZ7773235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist