Provider Demographics
NPI:1194029967
Name:CAROSO, JESSICA M (CCC-SLP)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:M
Last Name:CAROSO
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:350 NE 24TH ST APT 1003
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33137-4878
Mailing Address - Country:US
Mailing Address - Phone:860-416-7248
Mailing Address - Fax:305-503-7173
Practice Address - Street 1:350 NE 24TH ST APT 1003
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33137-4878
Practice Address - Country:US
Practice Address - Phone:860-416-7248
Practice Address - Fax:305-503-7173
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-07
Last Update Date:2022-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA11392235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist