Provider Demographics
NPI:1609247709
Name:ROIZ-RIVERA, JACKLYN (MS)
Entity Type:Individual
Prefix:MRS
First Name:JACKLYN
Middle Name:
Last Name:ROIZ-RIVERA
Suffix:
Gender:F
Credentials:MS
Other - Prefix:MS
Other - First Name:JACKLYN
Other - Middle Name:
Other - Last Name:ROIZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:11251 NW 20TH ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33172-1859
Mailing Address - Country:US
Mailing Address - Phone:305-778-9198
Mailing Address - Fax:
Practice Address - Street 1:11251 NW 20TH ST
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33172-1859
Practice Address - Country:US
Practice Address - Phone:305-778-9198
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-10-14
Last Update Date:2015-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSZ7261235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist