Provider Demographics
NPI:1114043817
Name:FREITAS, VANESSA MARIE (MA CCC-SLP)
Entity Type:Individual
Prefix:MISS
First Name:VANESSA
Middle Name:MARIE
Last Name:FREITAS
Suffix:
Gender:F
Credentials:MA CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:91-2080 KAIOLI ST.
Mailing Address - Street 2:# 4701
Mailing Address - City:EWA BEACH
Mailing Address - State:HI
Mailing Address - Zip Code:96706
Mailing Address - Country:US
Mailing Address - Phone:808-638-4253
Mailing Address - Fax:
Practice Address - Street 1:94-144 FARRINGTON HWY.
Practice Address - Street 2:SUITE 115
Practice Address - City:WAIPAHU
Practice Address - State:HI
Practice Address - Zip Code:96797
Practice Address - Country:US
Practice Address - Phone:808-678-3814
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HISP-870235Z00000X
12069372235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist