Provider Demographics
NPI:1356169528
Name:CHAPARRO, JESSICA ANGELICA (CF-SLP)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:ANGELICA
Last Name:CHAPARRO
Suffix:
Gender:F
Credentials:CF-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:700 W STEVENS ST
Mailing Address - Street 2:
Mailing Address - City:CARLSBAD
Mailing Address - State:NM
Mailing Address - Zip Code:88220-4958
Mailing Address - Country:US
Mailing Address - Phone:575-234-3305
Mailing Address - Fax:575-725-5999
Practice Address - Street 1:1801 W LEA ST
Practice Address - Street 2:
Practice Address - City:CARLSBAD
Practice Address - State:NM
Practice Address - Zip Code:88220-3785
Practice Address - Country:US
Practice Address - Phone:575-234-3303
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-27
Last Update Date:2024-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMSAH-2024-0360235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist