| Doctor Name: | MRS. MIRYAM BORDOW DACONCEICAO |
| NPI Number: | 1457696825 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | |
| License Number: | SLP006725 |
| Business Practice Address: | 36261 Okefenokee Dr Folkston, GA - 315377853 |
| Business Phone Number: | 9124967396 |
| Business Fax Number: | 9124962087 |
| Mailing Address: | 36261 Okefenokee Dr, FOLKSTON |
| State: | GA |
| Postal Code: | 315377853 |
| Phone Number: | 9124967396 |
| Fax Number: | 9124962087 |
| NPI Enumeration Date: | 12/11/2012 |
| NPI Last Update Date: | 12/11/2012 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 235Z00000X |
| License Number: | SLP006725 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | GA |
| 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 |