Provider Demographics
NPI:1730349077
Name:CRUZ, MONICA (MS CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:MONICA
Middle Name:
Last Name:CRUZ
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 1:24062 SW 112TH CT
Mailing Address - Street 2:
Mailing Address - City:HOMESTEAD
Mailing Address - State:FL
Mailing Address - Zip Code:33032-3139
Mailing Address - Country:US
Mailing Address - Phone:305-213-5295
Mailing Address - Fax:
Practice Address - Street 1:24062 SW 112TH CT
Practice Address - Street 2:
Practice Address - City:HOMESTEAD
Practice Address - State:FL
Practice Address - Zip Code:33032-3139
Practice Address - Country:US
Practice Address - Phone:305-213-5295
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-10
Last Update Date:2011-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL103TB0200X
FLSA 11038235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
No103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral