Basic Information
Provider Information
NPI: 1497990204
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: MENDEZ
FirstName: VALERIE
MiddleName: C
NamePrefix:  
NameSuffix:  
Credential: CCC-SLP
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 3031 IH 10 W
Address2:  
City: SAN ANTONIO
State: TX
PostalCode: 782015159
CountryCode: US
TelephoneNumber: 2107311300
FaxNumber: 2107311385
Practice Location
Address1: 3031 IH 10 W
Address2:  
City: SAN ANTONIO
State: TX
PostalCode: 782015159
CountryCode: US
TelephoneNumber: 2107311300
FaxNumber: 2107311385
Other Information
ProviderEnumerationDate: 12/08/2008
LastUpdateDate: 12/08/2008
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
235Z00000X19280TXY Speech, Language and Hearing Service ProvidersSpeech-Language Pathologist 

No ID Information.


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