Provider Demographics
NPI:1053557454
Name:HERNANDEZ, JUAN CARLO JR (MS, CCC-SLP)
Entity type:Individual
Prefix:MR
First Name:JUAN
Middle Name:CARLO
Last Name:HERNANDEZ
Suffix:JR
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 1:1608 18TH AVE N
Mailing Address - Street 2:
Mailing Address - City:LAKE WORTH BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33460-6406
Mailing Address - Country:US
Mailing Address - Phone:561-876-5694
Mailing Address - Fax:
Practice Address - Street 1:5555 PURDY LN
Practice Address - Street 2:
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33415-7101
Practice Address - Country:US
Practice Address - Phone:561-432-2300
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-06
Last Update Date:2025-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA23795235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist