Provider Demographics
NPI:1861016644
Name:CRUZ, JESSALEE R
Entity Type:Individual
Prefix:
First Name:JESSALEE
Middle Name:R
Last Name:CRUZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:218 EDMUND ST # A
Mailing Address - Street 2:
Mailing Address - City:HAMILTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08610-5119
Mailing Address - Country:US
Mailing Address - Phone:609-901-1011
Mailing Address - Fax:
Practice Address - Street 1:218 EDMUND ST # A
Practice Address - Street 2:
Practice Address - City:HAMILTON
Practice Address - State:NJ
Practice Address - Zip Code:08610-5119
Practice Address - Country:US
Practice Address - Phone:609-901-1011
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-08
Last Update Date:2020-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist