| Doctor Name: | MISS JESSELYN M PROENZA |
| NPI Number: | 1043655954 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | SLP |
| License Number: | 985 |
| Business Practice Address: | Carretera 172 Urbanizacion Turabo Gardens Caguas, PR - 00726 |
| Business Phone Number: | 7877433038 |
| Business Fax Number: | |
| Mailing Address: | 111 Calle Cecilio Urbina, Portal De Sofia Apt.4006 GUAYNABO |
| State: | PR |
| Postal Code: | 009695958 |
| Phone Number: | 7879494108 |
| Fax Number: | 7877205558 |
| NPI Enumeration Date: | 05/06/2013 |
| NPI Last Update Date: | 05/06/2013 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 235Z00000X |
| License Number: | 985 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | PR |
| Taxonomy Type: | Speech, Language and Hearing Service Providers |
| Taxonomy Classification: | Speech-Language Pathologist |
| Taxonomy Specialization: | |
| Taxonomy Definition: | A speech pathologist is a person qualified by a master |