Individual
MRS. IVONNE CARMEN RANDOLPH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MACCCSLP
Contact information
Practice address
5791 FALLING TREE LN, PORT ORANGE, FL 32127-7993
(407) 595-2710
Mailing address
5791 FALLING TREE LN, PORT ORANGE, FL 32127-7993
(407) 595-2710
Taxonomy
Speciality
Code
Description
License number
State
222Q00000X
Developmental Therapist
—
—
235Z00000X
Speech-Language Pathologist
Primary
SA 1206
FL
252Y00000X
Early Intervention Provider Agency
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
884535200
—
FL
Enumeration date
02/07/2007
Last updated
02/16/2025
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