Basic Information
| Provider Information | |||||||||
| NPI: | 1003156845 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | LUNA | ||||||||
| FirstName: | DENISE | ||||||||
| MiddleName: | ELAINE | ||||||||
| NamePrefix: | MRS. | ||||||||
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| Credential: | M.S.,C.C.C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1346 CORDOVA AVE | ||||||||
| Address2: | |||||||||
| City: | FORT MYERS | ||||||||
| State: | FL | ||||||||
| PostalCode: | 339016633 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2399946062 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 1346 CORDOVA AVE | ||||||||
| Address2: | |||||||||
| City: | FORT MYERS | ||||||||
| State: | FL | ||||||||
| PostalCode: | 339016633 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2399946062 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/14/2013 | ||||||||
| LastUpdateDate: | 02/14/2013 | ||||||||
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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 | 235Z00000X | SA1188 | FL | Y | Speech, Language and Hearing Service Providers | Speech-Language Pathologist |
No ID Information.