Provider Demographics
NPI:1306974142
Name:HERBOZO, BEVERLY STEPHANIE (MS CCC-SLP)
Entity type:Individual
Prefix:MS
First Name:BEVERLY
Middle Name:STEPHANIE
Last Name:HERBOZO
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 1:1075 93RD ST
Mailing Address - Street 2:UNIT 306
Mailing Address - City:BAY HARBOR ISLANDS
Mailing Address - State:FL
Mailing Address - Zip Code:33154-2389
Mailing Address - Country:US
Mailing Address - Phone:786-859-6146
Mailing Address - Fax:
Practice Address - Street 1:1075 93RD ST
Practice Address - Street 2:UNIT 306
Practice Address - City:BAY HARBOR ISLANDS
Practice Address - State:FL
Practice Address - Zip Code:33154-2389
Practice Address - Country:US
Practice Address - Phone:786-859-6146
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA7596235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist