Healthcare Provider Details

I. General information

NPI: 1992524227
Provider Name (Legal Business Name): JENNIFER VALLADARES
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/03/2024
Last Update Date: 12/01/2025
Certification Date: 12/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

125 KINGSTON RD
BALTIMORE MD
21220-4815
US

IV. Provider business mailing address

18562 NW 19TH ST
PEMBROKE PINES FL
33029-3820
US

V. Phone/Fax

Practice location:
  • Phone: 443-809-0138
  • Fax:
Mailing address:
  • Phone: 954-559-0633
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberSZ12168
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number11829
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: