Provider Demographics
NPI:1184224388
Name:MORALES CRESPO, JADALIS
Entity Type:Individual
Prefix:
First Name:JADALIS
Middle Name:
Last Name:MORALES CRESPO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:URB. COUNTRY CLUB
Mailing Address - Street 2:HA 72 CALLE 218
Mailing Address - City:CAROLINA
Mailing Address - State:PR
Mailing Address - Zip Code:00982
Mailing Address - Country:US
Mailing Address - Phone:787-400-1132
Mailing Address - Fax:
Practice Address - Street 1:EDIF WILLIAM DAVILA
Practice Address - Street 2:CARR #2 KM 11.9
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00960
Practice Address - Country:US
Practice Address - Phone:787-798-8570
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-27
Last Update Date:2020-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR44321235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist