Provider Demographics
NPI:1548721442
Name:MEDINA, ALMA L (MS-CCC/SLP)
Entity type:Individual
Prefix:
First Name:ALMA
Middle Name:L
Last Name:MEDINA
Suffix:
Gender:F
Credentials:MS-CCC/SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6102 NEWPORT VILLAGE WAY
Mailing Address - Street 2:
Mailing Address - City:LAKE WORTH
Mailing Address - State:FL
Mailing Address - Zip Code:33463-7330
Mailing Address - Country:US
Mailing Address - Phone:561-602-8669
Mailing Address - Fax:
Practice Address - Street 1:1201 12TH AVE S
Practice Address - Street 2:
Practice Address - City:LAKE WORTH
Practice Address - State:FL
Practice Address - Zip Code:33460-5409
Practice Address - Country:US
Practice Address - Phone:561-586-7404
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-25
Last Update Date:2019-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA3338235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist