Provider Demographics
NPI:1073867412
Name:TALAVERA, JAMIELEE (SLP)
Entity Type:Individual
Prefix:
First Name:JAMIELEE
Middle Name:
Last Name:TALAVERA
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:HC-04 BOX 48700
Mailing Address - Street 2:
Mailing Address - City:HATILLO
Mailing Address - State:PR
Mailing Address - Zip Code:00659
Mailing Address - Country:US
Mailing Address - Phone:787-640-6545
Mailing Address - Fax:787-817-0597
Practice Address - Street 1:CARR.2 KM 79.4 AVE. MIRAMAR 00612
Practice Address - Street 2:#1141 BO. HATO ABAJO
Practice Address - City:ARECIBO
Practice Address - State:PR
Practice Address - Zip Code:00612
Practice Address - Country:US
Practice Address - Phone:787-817-0597
Practice Address - Fax:787-817-0597
Is Sole Proprietor?:No
Enumeration Date:2012-11-07
Last Update Date:2012-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR1099235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist