Provider Demographics
NPI:1013300094
Name:SEPULVEDA, JESSICA L (MS)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:L
Last Name:SEPULVEDA
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:AE14 CALLE RIO HUMACAO
Mailing Address - Street 2:URB. RIO HONDO 2
Mailing Address - City:BAYAMON
Mailing Address - State:PR
Mailing Address - Zip Code:00961-3201
Mailing Address - Country:US
Mailing Address - Phone:787-439-8517
Mailing Address - Fax:
Practice Address - Street 1:AE14 CALLE RIO HUMACAO
Practice Address - Street 2:URB. RIO HONDO 2
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00961-3201
Practice Address - Country:US
Practice Address - Phone:787-439-8517
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-03-14
Last Update Date:2015-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR1074235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist