Healthcare Provider Details

I. General information

NPI: 1144458050
Provider Name (Legal Business Name): JENNIFER LYNN MORALES S.L.P.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/30/2009
Last Update Date: 06/30/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1101 E SCHUSTER AVE
EL PASO TX
79902-4659
US

IV. Provider business mailing address

1101 E SCHUSTER AVE
EL PASO TX
79902-4659
US

V. Phone/Fax

Practice location:
  • Phone: 915-544-8484
  • Fax: 915-496-0751
Mailing address:
  • Phone: 915-544-8484
  • Fax: 915-496-0751

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number101092
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: