Provider Demographics
NPI:1033231139
Name:DE JESUS, ANNIE (SLP)
Entity Type:Individual
Prefix:MS
First Name:ANNIE
Middle Name:
Last Name:DE JESUS
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10829 SW 232ND ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33170-7535
Mailing Address - Country:US
Mailing Address - Phone:305-321-0097
Mailing Address - Fax:305-971-6551
Practice Address - Street 1:10829 SW 232ND ST
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33170-7535
Practice Address - Country:US
Practice Address - Phone:305-321-0097
Practice Address - Fax:305-971-6551
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-06
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA 3372235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist