Provider Demographics
NPI:1467192757
Name:CORDERO LEBRON, GRACIELA MARIE (SPEECH THERAPIST)
Entity Type:Individual
Prefix:
First Name:GRACIELA
Middle Name:MARIE
Last Name:CORDERO LEBRON
Suffix:
Gender:F
Credentials:SPEECH THERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:HC 1 BOX 6440
Mailing Address - Street 2:
Mailing Address - City:ARROYO
Mailing Address - State:PR
Mailing Address - Zip Code:00714-9617
Mailing Address - Country:US
Mailing Address - Phone:787-596-3390
Mailing Address - Fax:
Practice Address - Street 1:81 CALLE MORSE # B
Practice Address - Street 2:
Practice Address - City:ARROYO
Practice Address - State:PR
Practice Address - Zip Code:00714-2764
Practice Address - Country:US
Practice Address - Phone:787-242-5832
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-01
Last Update Date:2022-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR75862355S0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR7586OtherTHERAPIST LICENCE
PR7586OtherSPEECH THERAPIST