=====================================================
General NPI Number Information
=====================================================
NPI Number | 1699603571
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | BLUEWAVE SPEECH & LANGUAGE THERAPY INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/12/2026
-----------------------------------------------------
Last Update Date | 05/12/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 36113 CEDAR BLVD
-----------------------------------------------------
City | NEWARK
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 94560-1933
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 510-371-0831
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 39116 FREMONT HUB STE 1090
-----------------------------------------------------
City | FREMONT
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 94538-1328
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 510-371-0831
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT/CEO, SLP
-----------------------------------------------------
Name | JENNIFER MARIE PERRY
-----------------------------------------------------
Credential | M.S.
-----------------------------------------------------
Telephone | 510-402-3573
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 235Z00000X
-----------------------------------------------------
Taxonomy Name | Speech-Language Pathologist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------