Provider Demographics
NPI:1518521947
Name:PEREZ-MALDONADO, ILEANA M (MS CCC-SLP)
Entity Type:Individual
Prefix:
First Name:ILEANA
Middle Name:M
Last Name:PEREZ-MALDONADO
Suffix:
Gender:F
Credentials:MS CCC-SLP
Other - Prefix:
Other - First Name:ILEANA
Other - Middle Name:M
Other - Last Name:PEREZ
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MS CCC-SLP
Mailing Address - Street 1:60 BRIMLEY DR
Mailing Address - Street 2:
Mailing Address - City:FREDERICKSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:22406-5148
Mailing Address - Country:US
Mailing Address - Phone:540-369-6184
Mailing Address - Fax:
Practice Address - Street 1:60 BRIMLEY DR
Practice Address - Street 2:
Practice Address - City:FREDERICKSBURG
Practice Address - State:VA
Practice Address - Zip Code:22406-5148
Practice Address - Country:US
Practice Address - Phone:540-369-6184
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-05-01
Last Update Date:2024-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2202009135235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist