Provider Demographics
NPI:1245651660
Name:HERNANDEZ-DE JESUS, ELIZABETH (MA, CCC-SLP)
Entity type:Individual
Prefix:MS
First Name:ELIZABETH
Middle Name:
Last Name:HERNANDEZ-DE JESUS
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2409 SEDGE GRASS WAY
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32824-4489
Mailing Address - Country:US
Mailing Address - Phone:407-232-3103
Mailing Address - Fax:
Practice Address - Street 1:2409 SEDGE GRASS WAY
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32824-4489
Practice Address - Country:US
Practice Address - Phone:407-232-3103
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-01-02
Last Update Date:2023-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA13517235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist