Basic Information
| Provider Information | |||||||||
| NPI: | 1174825111 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | VALDEZ | ||||||||
| FirstName: | VANESSA | ||||||||
| MiddleName: | C | ||||||||
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| Credential: | MS, CCC-SLP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 9900 N CENTRAL EXPY | ||||||||
| Address2: | SUITE 300 | ||||||||
| City: | DALLAS | ||||||||
| State: | TX | ||||||||
| PostalCode: | 752314395 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2142650420 | ||||||||
| FaxNumber: | 2142650737 | ||||||||
| Practice Location | |||||||||
| Address1: | 9900 N CENTRAL EXPY | ||||||||
| Address2: | SUITE 300 | ||||||||
| City: | DALLAS | ||||||||
| State: | TX | ||||||||
| PostalCode: | 752314395 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2142650420 | ||||||||
| FaxNumber: | 2142650737 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/24/2010 | ||||||||
| LastUpdateDate: | 11/24/2010 | ||||||||
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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 | 105058 | TX | Y | Speech, Language and Hearing Service Providers | Speech-Language Pathologist |
ID Information
| ID | Type | State | Issuer | Description | 207164901 | 05 | TX | MEDICAID | 149984001 | 05 | TX | MEDICAID |