Provider Demographics
NPI:1124645734
Name:ZASTROW, JOANAVEL JOVILLE (MA, CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:JOANAVEL
Middle Name:JOVILLE
Last Name:ZASTROW
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:JOANAVEL
Other - Middle Name:JALANDONI
Other - Last Name:JOVILLE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4400 SW 113TH AVE APT 4413
Mailing Address - Street 2:
Mailing Address - City:MIRAMAR
Mailing Address - State:FL
Mailing Address - Zip Code:33025-8038
Mailing Address - Country:US
Mailing Address - Phone:206-549-4568
Mailing Address - Fax:
Practice Address - Street 1:4400 SW 113TH AVE APT 4413
Practice Address - Street 2:
Practice Address - City:MIRAMAR
Practice Address - State:FL
Practice Address - Zip Code:33025-8038
Practice Address - Country:US
Practice Address - Phone:206-549-4568
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-30
Last Update Date:2020-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA14900235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist