Provider Demographics
NPI:1962908384
Name:MEDINA VALENTIN, RAQUEL (SLPA,ITDS)
Entity type:Individual
Prefix:MISS
First Name:RAQUEL
Middle Name:
Last Name:MEDINA VALENTIN
Suffix:
Gender:F
Credentials:SLPA,ITDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1737 ORANGE VIEW WAY
Mailing Address - Street 2:
Mailing Address - City:SAINT CLOUD
Mailing Address - State:FL
Mailing Address - Zip Code:34769-5403
Mailing Address - Country:US
Mailing Address - Phone:787-508-1310
Mailing Address - Fax:
Practice Address - Street 1:4119 NEPTUNE RD
Practice Address - Street 2:
Practice Address - City:SAINT CLOUD
Practice Address - State:FL
Practice Address - Zip Code:34769-6741
Practice Address - Country:US
Practice Address - Phone:407-913-1010
Practice Address - Fax:407-992-8697
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-04
Last Update Date:2021-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL252Y00000X
2355S0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant
No252Y00000XAgenciesEarly Intervention Provider Agency