Provider Demographics
NPI:1750517280
Name:BOTERO, VANESSA (MS CCC-SLP)
Entity type:Individual
Prefix:
First Name:VANESSA
Middle Name:
Last Name:BOTERO
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 1:819 NOTTINGHAM ST
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32803-1019
Mailing Address - Country:US
Mailing Address - Phone:786-473-5233
Mailing Address - Fax:
Practice Address - Street 1:819 NOTTINGHAM ST
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32803-1019
Practice Address - Country:US
Practice Address - Phone:786-473-5233
Practice Address - Fax:786-473-5233
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-10
Last Update Date:2018-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA10136235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty