Provider Demographics
NPI:1841529864
Name:BROUWER, MIA
Entity type:Individual
Prefix:MS
First Name:MIA
Middle Name:
Last Name:BROUWER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1818 SW 1ST STREET
Mailing Address - Street 2:SUITE 1502
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33129-1179
Mailing Address - Country:US
Mailing Address - Phone:305-803-5360
Mailing Address - Fax:305-665-5787
Practice Address - Street 1:1441 SW 1ST STREET
Practice Address - Street 2:# 1502
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33129-2202
Practice Address - Country:US
Practice Address - Phone:305-541-3400
Practice Address - Fax:305-541-3344
Is Sole Proprietor?:Yes
Enumeration Date:2009-12-22
Last Update Date:2011-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSZ4891235Z00000X
FLSA10507235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL002098700Medicaid