Provider Demographics
NPI:1154758688
Name:MORALES, LOURDES E (SLP)
Entity type:Individual
Prefix:
First Name:LOURDES
Middle Name:E
Last Name:MORALES
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 CALLE CISNE
Mailing Address - Street 2:URB. JARDNS DE BAYAMONTE
Mailing Address - City:BAYAMON
Mailing Address - State:PR
Mailing Address - Zip Code:00956-6634
Mailing Address - Country:US
Mailing Address - Phone:787-568-7795
Mailing Address - Fax:
Practice Address - Street 1:EXT. DE FOREST HILLS
Practice Address - Street 2:CALLE ATENAS R-145
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00956
Practice Address - Country:US
Practice Address - Phone:787-568-7795
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-30
Last Update Date:2013-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR519235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRLICENCE NO. 519OtherREGISTRY CERTIFICATE