Provider Demographics
NPI:1215479878
Name:ACEVEDO, JEANNETTE
Entity type:Individual
Prefix:
First Name:JEANNETTE
Middle Name:
Last Name:ACEVEDO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:106 VOSS CT
Mailing Address - Street 2:
Mailing Address - City:SEBRING
Mailing Address - State:FL
Mailing Address - Zip Code:33876-6022
Mailing Address - Country:US
Mailing Address - Phone:646-234-5587
Mailing Address - Fax:
Practice Address - Street 1:106 VOSS CT
Practice Address - Street 2:
Practice Address - City:SEBRING
Practice Address - State:FL
Practice Address - Zip Code:33876-6022
Practice Address - Country:US
Practice Address - Phone:646-234-5587
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-11-14
Last Update Date:2016-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL14528235Z00000X
NY024484235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist