Provider Demographics
NPI:1265885891
Name:ACOSTA ROJAS, MICHELLE MARIE
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:MARIE
Last Name:ACOSTA ROJAS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8851 NW 110TH PL
Mailing Address - Street 2:UNIT 1402
Mailing Address - City:DORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33178-1570
Mailing Address - Country:US
Mailing Address - Phone:305-815-8938
Mailing Address - Fax:
Practice Address - Street 1:6405 NW 36TH ST
Practice Address - Street 2:#105
Practice Address - City:VIRGINIA GARDENS
Practice Address - State:FL
Practice Address - Zip Code:33166-6974
Practice Address - Country:US
Practice Address - Phone:305-526-2426
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-07-19
Last Update Date:2016-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSI 29212355S0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant