Provider Demographics
NPI:1669784690
Name:ALFONSO, JILANA B (MS, CCC/SLP)
Entity type:Individual
Prefix:MRS
First Name:JILANA
Middle Name:B
Last Name:ALFONSO
Suffix:
Gender:F
Credentials:MS, CCC/SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1520 WOOD DALE TER
Mailing Address - Street 2:
Mailing Address - City:WELLINGTON
Mailing Address - State:FL
Mailing Address - Zip Code:33414-9095
Mailing Address - Country:US
Mailing Address - Phone:561-386-9407
Mailing Address - Fax:
Practice Address - Street 1:1520 WOOD DALE TER
Practice Address - Street 2:
Practice Address - City:WELLINGTON
Practice Address - State:FL
Practice Address - Zip Code:33414-9095
Practice Address - Country:US
Practice Address - Phone:561-386-9407
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-07
Last Update Date:2010-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA1570235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist