Provider Demographics
NPI:1558488304
Name:RAMIREZ-ALMODOVAR, GISSELLE A (MS, CCC-SLP)
Entity type:Individual
Prefix:
First Name:GISSELLE
Middle Name:A
Last Name:RAMIREZ-ALMODOVAR
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 1:14291 SW 120TH ST STE 103
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33186-7287
Mailing Address - Country:US
Mailing Address - Phone:305-385-0168
Mailing Address - Fax:305-385-0182
Practice Address - Street 1:14291 SW 120TH ST STE 103
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33186-7287
Practice Address - Country:US
Practice Address - Phone:305-385-0168
Practice Address - Fax:305-385-0182
Is Sole Proprietor?:No
Enumeration Date:2007-03-26
Last Update Date:2011-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA 8363235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL890504500Medicaid