Provider Demographics
NPI:1043655954
Name:PROENZA, JESSELYN M (SLP)
Entity Type:Individual
Prefix:MISS
First Name:JESSELYN
Middle Name:M
Last Name:PROENZA
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:111 CALLE CECILIO URBINA
Mailing Address - Street 2:PORTAL DE SOFIA APT.4006
Mailing Address - City:GUAYNABO
Mailing Address - State:PR
Mailing Address - Zip Code:00969-5958
Mailing Address - Country:US
Mailing Address - Phone:787-949-4108
Mailing Address - Fax:787-720-5558
Practice Address - Street 1:CARRETERA 172
Practice Address - Street 2:URBANIZACION TURABO GARDENS
Practice Address - City:CAGUAS
Practice Address - State:PR
Practice Address - Zip Code:00726
Practice Address - Country:US
Practice Address - Phone:787-743-3038
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-06
Last Update Date:2013-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR985235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist