Provider Demographics
NPI:1770991390
Name:TARTAK CORDOVA, JESSICA MARIE (MS-SLP)
Entity type:Individual
Prefix:MISS
First Name:JESSICA
Middle Name:MARIE
Last Name:TARTAK CORDOVA
Suffix:
Gender:F
Credentials:MS-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:779 CALLE PEDRO MARGARIT
Mailing Address - Street 2:FAIRVIEW
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00926-7714
Mailing Address - Country:US
Mailing Address - Phone:787-602-5545
Mailing Address - Fax:
Practice Address - Street 1:779 CALLE PEDRO MARGARIT
Practice Address - Street 2:FAIRVIEW
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00926-7714
Practice Address - Country:US
Practice Address - Phone:787-602-5545
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-28
Last Update Date:2014-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR1100235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist