Doctor Name: | JEISHA L VICENTY |
NPI Number: | 1790044048 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | |
License Number: | 1082 |
Business Practice Address: | D81 Calle C Costa De Oro Dorado, PR - 006462012 |
Business Phone Number: | 7877965900 |
Business Fax Number: | |
Mailing Address: | Po Box 953, DORADO |
State: | PR |
Postal Code: | 006460953 |
Phone Number: | 7876351850 |
Fax Number: | |
NPI Enumeration Date: | 05/07/2012 |
NPI Last Update Date: | 05/07/2012 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 235Z00000X |
License Number: | 1082 |
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 |