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General NPI Number Information
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NPI Number | 1215439633
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Entity Type | Individual
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Provider Name | JESSICA S. CORDERO
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Gender | Female
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Dates
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Enumeration Date | 03/01/2018
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Last Update Date | 02/12/2024
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Provider Practice Location Address
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Address Line | 22655 BAYSHORE RD
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City | PORT CHARLOTTE
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State | FL
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Zip | 33980-2018
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Country | US
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Telephone | 239-351-4787
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Fax |
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Provider Business Mailing Address
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Address Line | 3525 6TH AVE NE
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City | NAPLES
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State | FL
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Zip | 34120-4914
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Country | US
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Telephone | 954-298-7207
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 222Q00000X
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Taxonomy Name | Developmental Therapist
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 2355S0801X
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Taxonomy Name | Speech-Language Assistant
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License Number | SI-4635
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License Number State | FL
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Taxonomy #3
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Taxonomy Code | 106S00000X
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Taxonomy Name | Behavior Technician
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License Number |
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License Number State |
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