Doctor Name: | JENNIFER LIORAH TIELVES |
NPI Number: | 1992991293 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | MS, CCC/SLP |
License Number: | SA9225 |
Business Practice Address: | 23451 Sw 112th Ct Homestead, FL - 330327145 |
Business Phone Number: | 3058039139 |
Business Fax Number: | |
Mailing Address: | 23451 Sw 112th Ct, HOMESTEAD |
State: | FL |
Postal Code: | 330327145 |
Phone Number: | 3058039139 |
Fax Number: | |
NPI Enumeration Date: | 09/20/2007 |
NPI Last Update Date: | 08/07/2013 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 235Z00000X |
License Number: | SA9225 |
Healthcare Provider Taxonomy: (Secondary) | Y |
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 |