Provider Demographics
NPI:1265899280
Name:MONIQUETTE, CECILE (SLP)
Entity type:Individual
Prefix:
First Name:CECILE
Middle Name:
Last Name:MONIQUETTE
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:667 OLDE CAMELOT CIR
Mailing Address - Street 2:
Mailing Address - City:HAINES CITY
Mailing Address - State:FL
Mailing Address - Zip Code:33844-6731
Mailing Address - Country:US
Mailing Address - Phone:863-268-2903
Mailing Address - Fax:863-268-2906
Practice Address - Street 1:150 AVENUE B SE
Practice Address - Street 2:
Practice Address - City:WINTER HAVEN
Practice Address - State:FL
Practice Address - Zip Code:33880-3037
Practice Address - Country:US
Practice Address - Phone:863-268-2903
Practice Address - Fax:863-268-2906
Is Sole Proprietor?:No
Enumeration Date:2016-01-21
Last Update Date:2016-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSZ7412235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLSZ7412OtherSLP LIC. ID