Healthcare Provider Details

I. General information

NPI: 1699603571
Provider Name (Legal Business Name): BLUEWAVE SPEECH & LANGUAGE THERAPY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/12/2026
Last Update Date: 05/12/2026
Certification Date: 05/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

36113 CEDAR BLVD
NEWARK CA
94560-1933
US

IV. Provider business mailing address

39116 FREMONT HUB STE 1090
FREMONT CA
94538-1328
US

V. Phone/Fax

Practice location:
  • Phone: 510-371-0831
  • Fax:
Mailing address:
  • Phone: 510-371-0831
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State

VIII. Authorized Official

Name: JENNIFER MARIE PERRY
Title or Position: PRESIDENT/CEO, SLP
Credential: M.S.
Phone: 510-402-3573