Provider Demographics
NPI:1093084212
Name:ELIZONDO, VANNESA MARIE (SLP-CCC)
Entity Type:Individual
Prefix:
First Name:VANNESA
Middle Name:MARIE
Last Name:ELIZONDO
Suffix:
Gender:F
Credentials:SLP-CCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1814 E GRIFFIN PKWY
Mailing Address - Street 2:
Mailing Address - City:MISSION
Mailing Address - State:TX
Mailing Address - Zip Code:78572-3105
Mailing Address - Country:US
Mailing Address - Phone:956-519-2500
Mailing Address - Fax:956-519-2520
Practice Address - Street 1:700 E BRAVO BLVD STE C
Practice Address - Street 2:
Practice Address - City:ROMA
Practice Address - State:TX
Practice Address - Zip Code:78584-5742
Practice Address - Country:US
Practice Address - Phone:956-849-3703
Practice Address - Fax:956-849-3735
Is Sole Proprietor?:No
Enumeration Date:2011-12-16
Last Update Date:2011-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX102439235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist