Provider Demographics
NPI:1093293797
Name:CANTU, MARISSA BETANCOURT (SLP-A)
Entity Type:Individual
Prefix:
First Name:MARISSA
Middle Name:BETANCOURT
Last Name:CANTU
Suffix:
Gender:F
Credentials:SLP-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 92
Mailing Address - Street 2:
Mailing Address - City:RAYMONDVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78580-0092
Mailing Address - Country:US
Mailing Address - Phone:956-689-5301
Mailing Address - Fax:956-689-2004
Practice Address - Street 1:100 N EXPRESSWAY 77 STE I
Practice Address - Street 2:
Practice Address - City:RAYMONDVILLE
Practice Address - State:TX
Practice Address - Zip Code:78580-4010
Practice Address - Country:US
Practice Address - Phone:956-689-5301
Practice Address - Fax:956-689-2004
Is Sole Proprietor?:No
Enumeration Date:2018-08-03
Last Update Date:2018-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX331152355S0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant