Provider Demographics
NPI:1083193056
Name:HERNANDEZ, JACQUELINE ALLEGRO (SLP)
Entity Type:Individual
Prefix:MRS
First Name:JACQUELINE
Middle Name:ALLEGRO
Last Name:HERNANDEZ
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 1:1011 LARKWOOD CT
Mailing Address - Street 2:
Mailing Address - City:CONCORD
Mailing Address - State:CA
Mailing Address - Zip Code:94521-4528
Mailing Address - Country:US
Mailing Address - Phone:925-352-6761
Mailing Address - Fax:
Practice Address - Street 1:144 CONTINENTE AVE
Practice Address - Street 2:
Practice Address - City:BRENTWOOD
Practice Address - State:CA
Practice Address - Zip Code:94513-1999
Practice Address - Country:US
Practice Address - Phone:925-513-2440
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-10
Last Update Date:2018-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA24440235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist