Provider Demographics
NPI:1588712772
Name:NOBLE, GENICARMEN (MS, CCC-SLP)
Entity type:Individual
Prefix:
First Name:GENICARMEN
Middle Name:
Last Name:NOBLE
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2393 S CONGRESS AVE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33406-7628
Mailing Address - Country:US
Mailing Address - Phone:561-253-0422
Mailing Address - Fax:
Practice Address - Street 1:2393 S CONGRESS AVE
Practice Address - Street 2:SUITE 200
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33406-7651
Practice Address - Country:US
Practice Address - Phone:561-253-0422
Practice Address - Fax:561-649-0210
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-06
Last Update Date:2014-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA7648235Z00000X, 235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL889880400Medicaid
FL811891400Medicaid