Provider Demographics
NPI:1831205905
Name:VOSS DEHARDT, AFIENA (CCC-SLP, BCABA)
Entity type:Individual
Prefix:MRS
First Name:AFIENA
Middle Name:
Last Name:VOSS DEHARDT
Suffix:
Gender:F
Credentials:CCC-SLP, BCABA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4016 CORTEZ RD W
Mailing Address - Street 2:SUITE 1105
Mailing Address - City:BRADENTON
Mailing Address - State:FL
Mailing Address - Zip Code:34210-3110
Mailing Address - Country:US
Mailing Address - Phone:941-758-3559
Mailing Address - Fax:941-758-3499
Practice Address - Street 1:4016 CORTEZ RD W
Practice Address - Street 2:SUITE 1105
Practice Address - City:BRADENTON
Practice Address - State:FL
Practice Address - Zip Code:34210-3110
Practice Address - Country:US
Practice Address - Phone:941-758-3559
Practice Address - Fax:941-758-3499
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA5451235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL681293796Medicaid
FL886149800Medicaid