Healthcare Provider Details

I. General information

NPI: 1194443705
Provider Name (Legal Business Name): JENNIFER D RIVERA SLPA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/19/2022
Last Update Date: 09/09/2024
Certification Date: 09/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18115 N US HIGHWAY 41 STE 800
LUTZ FL
33549-6475
US

IV. Provider business mailing address

1200 N CENTRAL AVE STE 110
KISSIMMEE FL
34741-4439
US

V. Phone/Fax

Practice location:
  • Phone: 813-848-0341
  • Fax:
Mailing address:
  • Phone: 407-530-5063
  • Fax: 877-399-5578

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225500000X
TaxonomyRespiratory/Developmental/Rehabilitative Specialist/Technologist
License Number
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code2355S0801X
TaxonomySpeech-Language Assistant
License NumberSI5463
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code252Y00000X
TaxonomyEarly Intervention Provider Agency
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code222Q00000X
TaxonomyDevelopmental Therapist
License Number
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: