Individual
MISS MONICA PUENTE TABILA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.A., CCC-SLP
Contact information
Practice address
1806 REIS CT, ROCHESTER HILLS, MI 48309-3330
(248) 234-1150
(248) 659-1835
Mailing address
21650 W 11 MILE RD STE 209, SOUTHFIELD, MI 48076-3777
(248) 234-1150
(248) 659-1835
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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