Provider Demographics
NPI:1407571706
Name:OLIVARES, JHAELYN MARIE (MA, TSSLD, BE)
Entity Type:Individual
Prefix:
First Name:JHAELYN
Middle Name:MARIE
Last Name:OLIVARES
Suffix:
Gender:F
Credentials:MA, TSSLD, BE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:970 VERMONT ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11207-8497
Mailing Address - Country:US
Mailing Address - Phone:718-649-3155
Mailing Address - Fax:
Practice Address - Street 1:970 VERMONT ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11207-8497
Practice Address - Country:US
Practice Address - Phone:718-649-3155
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-10
Last Update Date:2022-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist