Provider Demographics
NPI:1952577637
Name:GIANNONI, JACQUELINE (SLP)
Entity Type:Individual
Prefix:
First Name:JACQUELINE
Middle Name:
Last Name:GIANNONI
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11 CALLE PALMERAS
Mailing Address - Street 2:PALMAS REALES 11
Mailing Address - City:HUMACAO
Mailing Address - State:PR
Mailing Address - Zip Code:00791-6000
Mailing Address - Country:US
Mailing Address - Phone:939-642-1635
Mailing Address - Fax:
Practice Address - Street 1:11 CALLE PALMERAS
Practice Address - Street 2:PALMAS REALES 11
Practice Address - City:HUMACAO
Practice Address - State:PR
Practice Address - Zip Code:00791-6000
Practice Address - Country:US
Practice Address - Phone:939-642-1635
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-02
Last Update Date:2008-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR602235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist