Provider Demographics
NPI:1255765434
Name:FIX, TODD RUSSELL (MA CCC-SLP)
Entity type:Individual
Prefix:MR
First Name:TODD
Middle Name:RUSSELL
Last Name:FIX
Suffix:
Gender:M
Credentials:MA CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:297 WOODGREEN LN
Mailing Address - Street 2:
Mailing Address - City:WINTER SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:32708-3023
Mailing Address - Country:US
Mailing Address - Phone:407-312-0213
Mailing Address - Fax:
Practice Address - Street 1:297 WOODGREEN LN
Practice Address - Street 2:
Practice Address - City:WINTER SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:32708-3023
Practice Address - Country:US
Practice Address - Phone:407-312-0213
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-08-24
Last Update Date:2013-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA6295235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist