Provider Demographics
NPI:1497834592
Name:WITKIND, MARK J (SLPD)
Entity type:Individual
Prefix:DR
First Name:MARK
Middle Name:J
Last Name:WITKIND
Suffix:
Gender:M
Credentials:SLPD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:425 HARDEE RD
Mailing Address - Street 2:
Mailing Address - City:CORAL GABLES
Mailing Address - State:FL
Mailing Address - Zip Code:33146-3510
Mailing Address - Country:US
Mailing Address - Phone:305-772-4054
Mailing Address - Fax:
Practice Address - Street 1:425 HARDEE RD
Practice Address - Street 2:
Practice Address - City:CORAL GABLES
Practice Address - State:FL
Practice Address - Zip Code:33146-3510
Practice Address - Country:US
Practice Address - Phone:305-772-4054
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-02
Last Update Date:2012-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA 1500235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist