Doctor Name: | MRS. IVONNE CARMEN RANDOLPH |
NPI Number: | 1922148451 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | MACCCSLP |
License Number: | SA 1206 |
Business Practice Address: | 2219 S Woodland Blvd Deland, FL - 327208628 |
Business Phone Number: | 3867369849 |
Business Fax Number: | |
Mailing Address: | 30135 Bluebell Ave W, EUSTIS |
State: | FL |
Postal Code: | 32736 |
Phone Number: | 3523570316 |
Fax Number: | |
NPI Enumeration Date: | 02/07/2007 |
NPI Last Update Date: | 07/09/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 235Z00000X |
License Number: | SA 1206 |
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 |