Provider Demographics
NPI:1649308487
Name:SOTO-DARDIZ, KATHERINE (MA CCC-SLP)
Entity type:Individual
Prefix:
First Name:KATHERINE
Middle Name:
Last Name:SOTO-DARDIZ
Suffix:
Gender:F
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 1:10813 LEADER LN
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32825-7221
Mailing Address - Country:US
Mailing Address - Phone:407-384-1919
Mailing Address - Fax:407-384-1919
Practice Address - Street 1:10813 LEADER LN
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32825-7221
Practice Address - Country:US
Practice Address - Phone:407-384-1919
Practice Address - Fax:407-384-1919
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-01
Last Update Date:2011-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA6509235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL886933200Medicaid