Basic Information
| Provider Information | |||||||||
| NPI: | 1962783282 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MACEDA | ||||||||
| FirstName: | JENNIFER | ||||||||
| MiddleName: | R | ||||||||
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| Credential: | AUD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1120 NW 14TH ST | ||||||||
| Address2: | 5TH FLOOR (CRB BUILDING) | ||||||||
| City: | MIAMI | ||||||||
| State: | FL | ||||||||
| PostalCode: | 331362107 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3052432000 | ||||||||
| FaxNumber: | 3052431851 | ||||||||
| Practice Location | |||||||||
| Address1: | 1120 NW 14TH ST | ||||||||
| Address2: | 5TH FLOOR (CRB BUILDING) | ||||||||
| City: | MIAMI | ||||||||
| State: | FL | ||||||||
| PostalCode: | 331362107 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3052432000 | ||||||||
| FaxNumber: | 3052431851 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/31/2011 | ||||||||
| LastUpdateDate: | 08/31/2011 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 231H00000X | AY1695 | FL | Y | Speech, Language and Hearing Service Providers | Audiologist |
No ID Information.