Basic Information
| Provider Information | |||||||||
| NPI: | 1114043817 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | FREITAS | ||||||||
| FirstName: | VANESSA | ||||||||
| MiddleName: | MARIE | ||||||||
| NamePrefix: | MISS | ||||||||
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| Credential: | MA CCC-SLP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 91-2080 KAIOLI ST. | ||||||||
| Address2: | # 4701 | ||||||||
| City: | EWA BEACH | ||||||||
| State: | HI | ||||||||
| PostalCode: | 96706 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8086384253 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 94-144 FARRINGTON HWY. | ||||||||
| Address2: | SUITE 115 | ||||||||
| City: | WAIPAHU | ||||||||
| State: | HI | ||||||||
| PostalCode: | 96797 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8086783814 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/22/2007 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 235Z00000X | SP-870 | HI | Y | Speech, Language and Hearing Service Providers | Speech-Language Pathologist | 235Z00000X | 12069372 | N | Speech, Language and Hearing Service Providers | Speech-Language Pathologist |
No ID Information.