Provider Demographics
NPI:1457829194
Name:HENRIQUEZ, JISEL (AUD)
Entity Type:Individual
Prefix:
First Name:JISEL
Middle Name:
Last Name:HENRIQUEZ
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1601 CLINT MOORE RD STE 215
Mailing Address - Street 2:
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33487-5716
Mailing Address - Country:US
Mailing Address - Phone:019-393-9561
Mailing Address - Fax:
Practice Address - Street 1:3401 PGA BLVD STE 410
Practice Address - Street 2:
Practice Address - City:PALM BEACH GARDENS
Practice Address - State:FL
Practice Address - Zip Code:33410-2825
Practice Address - Country:US
Practice Address - Phone:561-627-3773
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-11-12
Last Update Date:2020-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAY2235231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist