Provider Demographics
NPI:1093433153
Name:PEREZ, JENNA (MS, CCC-SLP)
Entity Type:Individual
Prefix:MS
First Name:JENNA
Middle Name:
Last Name:PEREZ
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5651 GRISSOM RD
Mailing Address - Street 2:
Mailing Address - City:LEON VALLEY
Mailing Address - State:TX
Mailing Address - Zip Code:78238-2220
Mailing Address - Country:US
Mailing Address - Phone:210-397-8158
Mailing Address - Fax:
Practice Address - Street 1:5651 GRISSOM RD
Practice Address - Street 2:
Practice Address - City:LEON VALLEY
Practice Address - State:TX
Practice Address - Zip Code:78238-2220
Practice Address - Country:US
Practice Address - Phone:210-397-8158
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-16
Last Update Date:2022-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX110376235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist