Provider Demographics
NPI:1306583794
Name:VELASQUEZ, GEOLENNE GEOVANA
Entity type:Individual
Prefix:
First Name:GEOLENNE
Middle Name:GEOVANA
Last Name:VELASQUEZ
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 1:1275 MARION AVE
Mailing Address - Street 2:
Mailing Address - City:PLAINFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:07060-3211
Mailing Address - Country:US
Mailing Address - Phone:908-307-4985
Mailing Address - Fax:
Practice Address - Street 1:1119 RARITAN AVE
Practice Address - Street 2:
Practice Address - City:HIGHLAND PARK
Practice Address - State:NJ
Practice Address - Zip Code:08904-3669
Practice Address - Country:US
Practice Address - Phone:732-352-9927
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-05-17
Last Update Date:2022-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist