Healthcare Provider Details

I. General information

NPI: 1528198470
Provider Name (Legal Business Name): JESSICA LYNN CUEVAS MS, CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/07/2007
Last Update Date: 06/18/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

871 OLD ALICE RD
BROWNSVILLE TX
78520-8268
US

IV. Provider business mailing address

5582 RUSTIC MANOR DR
BROWNSVILLE TX
78526-3937
US

V. Phone/Fax

Practice location:
  • Phone: 956-541-2102
  • Fax: 956-541-2502
Mailing address:
  • Phone: 956-621-2368
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number101389
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: