Provider Demographics
NPI:1083280663
Name:BELTRAN, CONSTANZA (SLPA)
Entity Type:Individual
Prefix:
First Name:CONSTANZA
Middle Name:
Last Name:BELTRAN
Suffix:
Gender:F
Credentials:SLPA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:29022 JACOBS RIVER DR # 1
Mailing Address - Street 2:
Mailing Address - City:KATY
Mailing Address - State:TX
Mailing Address - Zip Code:77494-6944
Mailing Address - Country:US
Mailing Address - Phone:650-219-1024
Mailing Address - Fax:
Practice Address - Street 1:29022 JACOBS RIVER DR # 1
Practice Address - Street 2:
Practice Address - City:KATY
Practice Address - State:TX
Practice Address - Zip Code:77494-6944
Practice Address - Country:US
Practice Address - Phone:650-219-1024
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-03
Last Update Date:2021-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX418322355S0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant