Randolph, Ivonne Carmen
Randolph, Ivonne Carmen is an sole proprietor health care provider with primary practice located at 5791 Falling Tree Ln , Port Orange FL 32127-7993. She recently has 2 registered licenses in different health care specialties including Agencies / Early Intervention Provider Agency, Speech, Language and Hearing Service Providers / Speech-Language Pathologist. Speech, Language and Hearing Service Providers / Speech-Language Pathologist is her primary health care specialty. Randolph, Ivonne Carmen can be contacted via phone (407) 595-2710.Contact Information
Primary practice address
5791 Falling Tree Ln
Port Orange FL 32127-7993
Phone: (407) 595-2710
Fax:
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Agencies / Early Intervention Provider Agency | 252Y00000X | ||
| Speech, Language and Hearing Service Providers / Speech-Language Pathologist | 235Z00000X | SA 1206 | Florida |
Profile Details
| NPI number | 1922148451 |
|---|---|
| LBN Legal business name | Randolph, Ivonne Carmen |
| Credentials | MACCCSLP |
| Entity | Individual |
| Sole proprietor 1 | Yes |
| Enumeration date | Feb 7th, 2007 |
| Last updated | Oct 15th, 2020 - about 4 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1922148451 | NPPES |
| Florida | MEDICAID | 884535200 |
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