Provider Demographics
NPI:1053713040
Name:RESTREPO, ALICIA MICHELLE (AUD)
Entity type:Individual
Prefix:DR
First Name:ALICIA
Middle Name:MICHELLE
Last Name:RESTREPO
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:ALICIA
Other - Middle Name:MICHELLE
Other - Last Name:THORNBERRY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1120 NW 14TH STREET
Mailing Address - Street 2:5TH FLOOR
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33136-3983
Mailing Address - Country:US
Mailing Address - Phone:305-243-2000
Mailing Address - Fax:305-243-1651
Practice Address - Street 1:1120 NW 14TH ST FL 5
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33136-2107
Practice Address - Country:US
Practice Address - Phone:305-243-2000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-09-22
Last Update Date:2017-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAY1899231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist