Provider Demographics
NPI:1871736132
Name:TOLEDO, MABEL LUCIA (MS, CCC, SLP)
Entity type:Individual
Prefix:
First Name:MABEL
Middle Name:LUCIA
Last Name:TOLEDO
Suffix:
Gender:F
Credentials:MS, CCC, SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:191 FRANKLIN AVE
Mailing Address - Street 2:SUITE 3
Mailing Address - City:HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06114-1386
Mailing Address - Country:US
Mailing Address - Phone:860-296-0094
Mailing Address - Fax:860-296-7125
Practice Address - Street 1:191 FRANKLIN AVE
Practice Address - Street 2:SUITE 3
Practice Address - City:HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06114-1386
Practice Address - Country:US
Practice Address - Phone:860-296-0094
Practice Address - Fax:860-296-7125
Is Sole Proprietor?:No
Enumeration Date:2009-04-15
Last Update Date:2009-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT001673235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
00000OtherNONE