Provider Demographics
NPI:1396961314
Name:LYTZYNCO PALACIYO, ESTHER G (SLP)
Entity type:Individual
Prefix:
First Name:ESTHER
Middle Name:G
Last Name:LYTZYNCO PALACIYO
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2001 S ANDREWS AVE
Mailing Address - Street 2:
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33316-3429
Mailing Address - Country:US
Mailing Address - Phone:786-494-0191
Mailing Address - Fax:
Practice Address - Street 1:2001 S ANDREWS AVE
Practice Address - Street 2:
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33316-3429
Practice Address - Country:US
Practice Address - Phone:786-394-0191
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-18
Last Update Date:2023-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9163235Z00000X, 235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL892120200Medicaid
FL812312800Medicaid