Provider Demographics
NPI:1881147023
Name:URIBE MEJIA, PAULA ANDREA (CCC SLP)
Entity type:Individual
Prefix:
First Name:PAULA
Middle Name:ANDREA
Last Name:URIBE MEJIA
Suffix:
Gender:F
Credentials:CCC SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 THORNBERRY BRANCH LN
Mailing Address - Street 2:
Mailing Address - City:DAYTONA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32124-3652
Mailing Address - Country:US
Mailing Address - Phone:386-872-4892
Mailing Address - Fax:386-256-2320
Practice Address - Street 1:201 THORNBERRY BRANCH LN
Practice Address - Street 2:
Practice Address - City:DAYTONA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32124-3652
Practice Address - Country:US
Practice Address - Phone:386-872-4892
Practice Address - Fax:386-256-2320
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-24
Last Update Date:2020-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA17652235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLSA17652OtherSLP LICENSE