Provider Demographics
NPI:1629863972
Name:SERRANO, VICENTE JESUS (MA)
Entity type:Individual
Prefix:
First Name:VICENTE
Middle Name:JESUS
Last Name:SERRANO
Suffix:
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3777 UNIVERSITY AVE
Mailing Address - Street 2:
Mailing Address - City:GURNEE
Mailing Address - State:IL
Mailing Address - Zip Code:60031-2943
Mailing Address - Country:US
Mailing Address - Phone:224-733-4357
Mailing Address - Fax:
Practice Address - Street 1:1110 CHESTNUT ST
Practice Address - Street 2:
Practice Address - City:WAUKEGAN
Practice Address - State:IL
Practice Address - Zip Code:60085-2982
Practice Address - Country:US
Practice Address - Phone:224-303-1800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-04-09
Last Update Date:2025-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist