Provider Demographics
NPI:1780994582
Name:IZQUIERDO, MELISSA MARINELLI (MS, CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:MELISSA
Middle Name:MARINELLI
Last Name:IZQUIERDO
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 1:13350 SW 88TH TER
Mailing Address - Street 2:UNIT B
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33186-1783
Mailing Address - Country:US
Mailing Address - Phone:305-510-8224
Mailing Address - Fax:
Practice Address - Street 1:2828 CORAL WAY
Practice Address - Street 2:SUITE 103
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33145-3214
Practice Address - Country:US
Practice Address - Phone:305-333-1414
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-14
Last Update Date:2010-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA10356235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist