Provider Demographics
NPI:1427929074
Name:RIVERA-LEBEAU, JARRETT WESLEY (MS CCC-SLP)
Entity type:Individual
Prefix:
First Name:JARRETT
Middle Name:WESLEY
Last Name:RIVERA-LEBEAU
Suffix:
Gender:M
Credentials:MS CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26 OAKLEY ST
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02124-1014
Mailing Address - Country:US
Mailing Address - Phone:617-466-9168
Mailing Address - Fax:
Practice Address - Street 1:26 OAKLEY ST
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02124-1014
Practice Address - Country:US
Practice Address - Phone:617-466-9168
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-09-16
Last Update Date:2025-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MASLP78131235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist