Provider Demographics
NPI:1750868519
Name:JACKSON MELENDEZ, KAREM JANITZ (MS , CCC-SLP)
Entity type:Individual
Prefix:
First Name:KAREM
Middle Name:JANITZ
Last Name:JACKSON MELENDEZ
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:BAIROA GOLDEN GATE II
Mailing Address - Street 2:H E7
Mailing Address - City:CAGUAS
Mailing Address - State:PR
Mailing Address - Zip Code:00727
Mailing Address - Country:US
Mailing Address - Phone:813-510-7308
Mailing Address - Fax:
Practice Address - Street 1:BAIROA GOLDEN GATE II
Practice Address - Street 2:STREET H E7
Practice Address - City:CAGUAS
Practice Address - State:PR
Practice Address - Zip Code:00727
Practice Address - Country:US
Practice Address - Phone:813-510-7308
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-25
Last Update Date:2023-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA17402235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLSZ8655Medicaid