Provider Demographics
NPI:1487104311
Name:ADORNO ALICEA, JIDALIZ (MSSLP)
Entity type:Individual
Prefix:MRS
First Name:JIDALIZ
Middle Name:
Last Name:ADORNO ALICEA
Suffix:
Gender:F
Credentials:MSSLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:RR 2 BOX 2006
Mailing Address - Street 2:
Mailing Address - City:TOA ALTA
Mailing Address - State:PR
Mailing Address - Zip Code:00953-8973
Mailing Address - Country:US
Mailing Address - Phone:787-414-3507
Mailing Address - Fax:
Practice Address - Street 1:RR 2 BOX 2006
Practice Address - Street 2:
Practice Address - City:TOA ALTA
Practice Address - State:PR
Practice Address - Zip Code:00953-8973
Practice Address - Country:US
Practice Address - Phone:787-414-3507
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-10-04
Last Update Date:2016-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR004115-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist