Provider Demographics
NPI:1861724676
Name:ALVAREZ, JESSICA JANEL (MS, CCC-SLP)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:JANEL
Last Name:ALVAREZ
Suffix:
Gender:F
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 1:9600 SIMS DR
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79925-7225
Mailing Address - Country:US
Mailing Address - Phone:915-434-8907
Mailing Address - Fax:817-789-6849
Practice Address - Street 1:9600 SIMS DR
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79925-7225
Practice Address - Country:US
Practice Address - Phone:915-434-8907
Practice Address - Fax:817-789-6849
Is Sole Proprietor?:No
Enumeration Date:2010-02-03
Last Update Date:2021-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX192062355S0801X
TX109834235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
No2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX149984001Medicaid
TX676535Medicare PIN
TX149984001Medicaid