Healthcare Provider Details

I. General information

NPI: 1346025129
Provider Name (Legal Business Name): NELLY PEREZ MS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/29/2023
Last Update Date: 09/29/2026
Certification Date: 09/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

114 1ST AVE NW STE B2
EPHRATA WA
98823-1602
US

IV. Provider business mailing address

114 1ST AVE NW STE B2
EPHRATA WA
98823-1602
US

V. Phone/Fax

Practice location:
  • Phone: 509-754-5752
  • Fax: 509-302-2840
Mailing address:
  • Phone: 509-754-5752
  • Fax: 509-302-2840

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberSLP.LL.70038724
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: