Provider Demographics
NPI:1841873247
Name:VEGA, NATALIE RENEE (SLP)
Entity type:Individual
Prefix:
First Name:NATALIE
Middle Name:RENEE
Last Name:VEGA
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12598 SW FORLI WAY
Mailing Address - Street 2:
Mailing Address - City:PORT SAINT LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34987-5450
Mailing Address - Country:US
Mailing Address - Phone:786-280-1810
Mailing Address - Fax:
Practice Address - Street 1:16303 EMERALD COVE RD
Practice Address - Street 2:
Practice Address - City:WESTON
Practice Address - State:FL
Practice Address - Zip Code:33331-3137
Practice Address - Country:US
Practice Address - Phone:786-280-1810
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-03
Last Update Date:2025-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSZ9712235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist