Individual
CAITLIN STREET AL-MUTAWA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
4202 E FPWLER AVENUE, TAMPA, FL 33620-6436
(813) 821-8038
(813) 974-4325
Mailing address
PO BOX 917770, ORLANDO, FL 32891-0001
(813) 821-8038
(813) 974-4325
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
SA16242
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
114876900
—
FL
01
—
NIF34
BLUE CROSS BLUE SHIELD
FL
Enumeration date
11/13/2018
Last updated
08/10/2022
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