Provider Demographics
NPI:1013192525
Name:HERNANDEZ, ROBERT DELACRUZ (MACCC, SLP)
Entity Type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:DELACRUZ
Last Name:HERNANDEZ
Suffix:
Gender:M
Credentials:MACCC, SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:203 S WESTERN AVE
Mailing Address - Street 2:
Mailing Address - City:TONASKET
Mailing Address - State:WA
Mailing Address - Zip Code:98855-8803
Mailing Address - Country:US
Mailing Address - Phone:509-486-2151
Mailing Address - Fax:
Practice Address - Street 1:203 S WESTERN AVE
Practice Address - Street 2:
Practice Address - City:TONASKET
Practice Address - State:WA
Practice Address - Zip Code:98855-8803
Practice Address - Country:US
Practice Address - Phone:509-486-2151
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-02
Last Update Date:2023-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK235235Z00000X
WALL60892459235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist