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Individual
MISS MONICA PUENTE TABILA
Active
Individual
MISS MONICA PUENTE TABILA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.A., CCC-SLP
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
7101001010
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0H72109
BLUE CROSS BLUE SHIELD
MI
05
—
MI9523
—
MI
Enumeration date
06/28/2015
Last updated
10/14/2017
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