Provider Demographics
NPI:1003010562
Name:FERNANDEZ, LENORE KRISTINE (MS, CCC-SLP)
Entity Type:Individual
Prefix:MISS
First Name:LENORE
Middle Name:KRISTINE
Last Name:FERNANDEZ
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 1:1526 LEWIS ST
Mailing Address - Street 2:
Mailing Address - City:KINGSVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78363-6634
Mailing Address - Country:US
Mailing Address - Phone:361-592-5760
Mailing Address - Fax:
Practice Address - Street 1:100 E ALTON GLOOR BLVD STE A
Practice Address - Street 2:
Practice Address - City:BROWNSVILLE
Practice Address - State:TX
Practice Address - Zip Code:78526-3354
Practice Address - Country:US
Practice Address - Phone:956-350-7329
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX101344235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX101344OtherSTATE LICENSE
TX13935OtherTSHA NUMBER
12067475OtherASHA NUMBER