Individual
LYNNETTE RENEE REVILLE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.A., CCC-A
Contact information
Practice address
1325 SOUTH APOLLO, MELBOURNE, FL 32901
(321) 508-6455
Mailing address
1325 S.APOLLO, DR BLENDA DICKENSON, MELBOURNE, FL 32901
Taxonomy
Speciality
Code
Description
License number
State
231H00000X
Audiologist
Primary
AY000498
FL
Other
Enumeration date
04/11/2008
Last updated
02/04/2014
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