Active NPI
Mirlene Principal, CCC-SLP
- Speech-Language Pathologist
- Lake Mary, FL
National Provider Identifier
1255855219
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Speech-Language Pathologist
- License
- SA15089
- Practice address
- 105 Mill Run Dr
Lake Mary, FL 32746-6110 - Phone
- (561) 452-5597
- NPI assigned
- Aug 1, 2017
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Speech-Language Pathologist | 235Z00000X | SA15089 | FL | Primary |
Addresses
Primary practice location
105 Mill Run Dr
Lake Mary, FL 32746-6110
Mailing address
105 Mill Run Dr
Lake Mary, FL 32746-6110
Phone (561) 452-5597
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| SA15089 | FL | MD | Speech-Language Pathologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1501545600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1771545600000",
"number": "1255855219",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "105 MILL RUN DR",
"city": "LAKE MARY",
"state": "FL",
"postal_code": "327466110",
"telephone_number": "561-452-5597"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "105 MILL RUN DR",
"city": "LAKE MARY",
"state": "FL",
"postal_code": "327466110",
"telephone_number": "561-452-5597"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PRINCIPAL",
"first_name": "MIRLENE",
"credential": "CCC-SLP",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2017-08-01",
"last_updated": "2026-02-20",
"certification_date": "2026-02-20",
"status": "A"
},
"taxonomies": [
{
"code": "235Z00000X",
"taxonomy_group": "",
"desc": "Speech-Language Pathologist",
"state": "FL",
"license": "SA15089",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Lake Mary, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 20, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.