Provider Demographics
NPI:1730645987
Name:DE LEON, JEANETTE GUADALUPE (MS, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:JEANETTE
Middle Name:GUADALUPE
Last Name:DE LEON
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 1:6927 NANSA DR
Mailing Address - Street 2:
Mailing Address - City:BROWNSVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78526-6621
Mailing Address - Country:US
Mailing Address - Phone:956-346-0577
Mailing Address - Fax:
Practice Address - Street 1:871 OLD ALICE RD STE 600
Practice Address - Street 2:
Practice Address - City:BROWNSVILLE
Practice Address - State:TX
Practice Address - Zip Code:78520-8274
Practice Address - Country:US
Practice Address - Phone:956-541-2102
Practice Address - Fax:956-541-2502
Is Sole Proprietor?:No
Enumeration Date:2019-02-13
Last Update Date:2019-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX110292235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist