Provider Demographics
NPI:1083115000
Name:CERPA AMADO, MAGDA BEATRIZ JESUS (MS,CCC-SLP)
Entity Type:Individual
Prefix:
First Name:MAGDA
Middle Name:BEATRIZ JESUS
Last Name:CERPA AMADO
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 1:12255 OXFORD CRESCENT CIR
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77082-1775
Mailing Address - Country:US
Mailing Address - Phone:832-703-9572
Mailing Address - Fax:
Practice Address - Street 1:12255 OXFORD CRESCENT CIR
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77082-1775
Practice Address - Country:US
Practice Address - Phone:832-703-9572
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-02-25
Last Update Date:2018-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX108466235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist