Provider Demographics
NPI:1841502119
Name:PARRIS, JACQUELINE (SLP, CCC)
Entity type:Individual
Prefix:MISS
First Name:JACQUELINE
Middle Name:
Last Name:PARRIS
Suffix:
Gender:F
Credentials:SLP, CCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:626 RIVERSIDE DR APT 4A
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10031-7206
Mailing Address - Country:US
Mailing Address - Phone:212-926-3143
Mailing Address - Fax:212-926-3143
Practice Address - Street 1:626 RIVERSIDE DR. 4A
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10031-7206
Practice Address - Country:US
Practice Address - Phone:212-926-3143
Practice Address - Fax:212-926-3143
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-02
Last Update Date:2010-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY012923-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist