Provider Demographics
NPI:1013769892
Name:PEREZ, JESSELE R (MA CCC-SLP, CBIS)
Entity Type:Individual
Prefix:
First Name:JESSELE
Middle Name:R
Last Name:PEREZ
Suffix:
Gender:F
Credentials:MA CCC-SLP, CBIS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3094 CALLE CARR
Mailing Address - Street 2:
Mailing Address - City:EAGLE PASS
Mailing Address - State:TX
Mailing Address - Zip Code:78852-5750
Mailing Address - Country:US
Mailing Address - Phone:830-513-5557
Mailing Address - Fax:
Practice Address - Street 1:3094 CALLE CARR
Practice Address - Street 2:
Practice Address - City:EAGLE PASS
Practice Address - State:TX
Practice Address - Zip Code:78852-5750
Practice Address - Country:US
Practice Address - Phone:830-513-5557
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-04-03
Last Update Date:2024-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX113631235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist