Provider Demographics
NPI:1558186056
Name:HERRIG, JUSTIN RICHARD (CF-SLP)
Entity type:Individual
Prefix:
First Name:JUSTIN
Middle Name:RICHARD
Last Name:HERRIG
Suffix:
Gender:M
Credentials:CF-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10851 SW 26TH CT
Mailing Address - Street 2:
Mailing Address - City:DAVIE
Mailing Address - State:FL
Mailing Address - Zip Code:33328-1008
Mailing Address - Country:US
Mailing Address - Phone:630-337-1131
Mailing Address - Fax:
Practice Address - Street 1:8569 PINES BLVD STE 209
Practice Address - Street 2:
Practice Address - City:PEMBROKE PINES
Practice Address - State:FL
Practice Address - Zip Code:33024-6620
Practice Address - Country:US
Practice Address - Phone:954-538-8588
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-11-19
Last Update Date:2024-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSZ12423235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist