1811211873 NPI number — MRS. JENNIFER D. CORA M.S., CCC-SLP, PHL

Table of content: MRS. JENNIFER D. CORA M.S., CCC-SLP, PHL (NPI 1811211873)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1811211873 NPI number — MRS. JENNIFER D. CORA M.S., CCC-SLP, PHL

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CORA
Provider First Name:
JENNIFER
Provider Middle Name:
D.
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
M.S., CCC-SLP, PHL
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
NOBLES HARRING
Provider Other First Name:
JENNIFER
Provider Other Middle Name:
D.
Provider Other Name Prefix Text:
MRS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
M.S., CCC-SLP, PHL
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1811211873
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/19/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
242 LA SERRANIA
Provider Second Line Business Mailing Address:
CALLE AZUCENA
Provider Business Mailing Address City Name:
CAGUAS
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00725-1808
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-653-9130
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
242 LA SERRANIA
Provider Second Line Business Practice Location Address:
CALLE AZUCENA
Provider Business Practice Location Address City Name:
CAGUAS
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00725-1808
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-653-9130
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/19/2010

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 235Z00000X , with the licence number:  776 , registered in the state of PR ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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