Provider Demographics
NPI:1952414716
Name:PEREZ, YVONNE CASTELLON (MA CCC/SLP)
Entity type:Individual
Prefix:
First Name:YVONNE
Middle Name:CASTELLON
Last Name:PEREZ
Suffix:
Gender:F
Credentials:MA CCC/SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10906 BUCKWATER CT
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32817-2953
Mailing Address - Country:US
Mailing Address - Phone:407-208-0494
Mailing Address - Fax:
Practice Address - Street 1:1211 PALMETTO AVE
Practice Address - Street 2:
Practice Address - City:WINTER PARK
Practice Address - State:FL
Practice Address - Zip Code:32789-4913
Practice Address - Country:US
Practice Address - Phone:407-647-4740
Practice Address - Fax:407-647-6415
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA6952235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL8886415Medicaid