Doctor Name: | MRS. JULISSA GAYLE IRACHETA |
NPI Number: | 1558767772 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | M.S., CCC-SLP |
License Number: | SA 13419 |
Business Practice Address: | 3901 Pueblo Trl Lake Worth, TX - 761352872 |
Business Phone Number: | 8172356357 |
Business Fax Number: | |
Mailing Address: | 3901 Pueblo Trl, LAKE WORTH |
State: | TX |
Postal Code: | 761352872 |
Phone Number: | 8172356357 |
Fax Number: | |
NPI Enumeration Date: | 11/16/2014 |
NPI Last Update Date: | 11/16/2014 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 235Z00000X |
License Number: | SA 13419 |
Healthcare Provider Taxonomy: (Secondary) | N |
State: | FL |
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 |