Provider Demographics
NPI:1396831103
Name:CANIZARES, CLARA (MS,CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:CLARA
Middle Name:
Last Name:CANIZARES
Suffix:
Gender:F
Credentials:MS,CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7310 SW 169TH ST
Mailing Address - Street 2:
Mailing Address - City:PALMETTO BAY
Mailing Address - State:FL
Mailing Address - Zip Code:33157-4863
Mailing Address - Country:US
Mailing Address - Phone:305-484-8365
Mailing Address - Fax:
Practice Address - Street 1:4026 N OCEAN BLVD
Practice Address - Street 2:
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33308-6420
Practice Address - Country:US
Practice Address - Phone:954-241-6726
Practice Address - Fax:954-241-6726
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-05
Last Update Date:2011-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA249235Z00000X
CA18171235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist