Provider Demographics
NPI:1689117038
Name:JEREZ, YANKEILA (SLP-CCC, TSSLD)
Entity Type:Individual
Prefix:MISS
First Name:YANKEILA
Middle Name:
Last Name:JEREZ
Suffix:
Gender:F
Credentials:SLP-CCC, TSSLD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:468 E 140TH ST
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10454-2752
Mailing Address - Country:US
Mailing Address - Phone:718-292-7391
Mailing Address - Fax:
Practice Address - Street 1:468 E 140TH ST
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10454-2752
Practice Address - Country:US
Practice Address - Phone:718-292-7391
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-12-02
Last Update Date:2016-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY025558235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist