Provider Demographics
NPI:1689180994
Name:BAEZ, JAILEENE E (MS SLP)
Entity type:Individual
Prefix:MRS
First Name:JAILEENE
Middle Name:E
Last Name:BAEZ
Suffix:
Gender:F
Credentials:MS SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:RR 7 BOX 17127
Mailing Address - Street 2:
Mailing Address - City:TOA ALTA
Mailing Address - State:PR
Mailing Address - Zip Code:00953-8844
Mailing Address - Country:US
Mailing Address - Phone:787-314-0373
Mailing Address - Fax:
Practice Address - Street 1:CARR 695 KM 2.0
Practice Address - Street 2:BO. HIGUILLAR
Practice Address - City:DORADO
Practice Address - State:PR
Practice Address - Zip Code:00646
Practice Address - Country:US
Practice Address - Phone:787-314-0373
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-12-21
Last Update Date:2021-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR004066235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR4893547OtherDRIVERS LICENSE