Provider Demographics
NPI:1558406934
Name:PEREZ, JEANNETTE M (MS CCC-SLP)
Entity Type:Individual
Prefix:
First Name:JEANNETTE
Middle Name:M
Last Name:PEREZ
Suffix:
Gender:F
Credentials:MS CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8550 SW 109TH AVE
Mailing Address - Street 2:# 5-203
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33173-4460
Mailing Address - Country:US
Mailing Address - Phone:305-412-9594
Mailing Address - Fax:
Practice Address - Street 1:8600 SW 92ND ST
Practice Address - Street 2:SUITE 204
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33156-7397
Practice Address - Country:US
Practice Address - Phone:305-279-2428
Practice Address - Fax:305-596-9996
Is Sole Proprietor?:No
Enumeration Date:2007-02-21
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA 7422235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist