Provider Demographics
NPI:1174039051
Name:MENCHACA, TESSA ALEXANDRA (AUD)
Entity Type:Individual
Prefix:
First Name:TESSA
Middle Name:ALEXANDRA
Last Name:MENCHACA
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1722 9TH ST
Mailing Address - Street 2:
Mailing Address - City:WICHITA FALLS
Mailing Address - State:TX
Mailing Address - Zip Code:76301-5003
Mailing Address - Country:US
Mailing Address - Phone:940-716-1637
Mailing Address - Fax:
Practice Address - Street 1:1722 9TH ST
Practice Address - Street 2:
Practice Address - City:WICHITA FALLS
Practice Address - State:TX
Practice Address - Zip Code:76301
Practice Address - Country:US
Practice Address - Phone:940-716-1637
Practice Address - Fax:940-217-2238
Is Sole Proprietor?:No
Enumeration Date:2017-12-14
Last Update Date:2018-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX81002231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist