| Doctor Name: | JODI TICE DE LA TORRE |
| NPI Number: | 1003115809 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | |
| License Number: | SA669 |
| Business Practice Address: | 5979 Nw 151st St Suite 108 Miami Lakes, FL - 330142400 |
| Business Phone Number: | 3053623300 |
| Business Fax Number: | 3053620202 |
| Mailing Address: | 2731 Oakbrook Mnr, WESTON |
| State: | FL |
| Postal Code: | 333323429 |
| Phone Number: | 9543892206 |
| Fax Number: | |
| NPI Enumeration Date: | 03/18/2011 |
| NPI Last Update Date: | 03/18/2011 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 235Z00000X |
| License Number: | SA669 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | FL |
| Taxonomy Type: | Speech, Language and Hearing Service Providers |
| Taxonomy Classification: | Speech-Language Pathologist |
| Taxonomy Specialization: | |
| Taxonomy Definition: | A speech pathologist is a person qualified by a master |