Provider Demographics
NPI:1194035402
Name:DE LA CRUZ, VERONICA (MS CCC SLP)
Entity Type:Individual
Prefix:MISS
First Name:VERONICA
Middle Name:
Last Name:DE LA CRUZ
Suffix:
Gender:F
Credentials:MS CCC SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:853 GLOBE AVE
Mailing Address - Street 2:
Mailing Address - City:BLUE MOUND
Mailing Address - State:TX
Mailing Address - Zip Code:76131-1540
Mailing Address - Country:US
Mailing Address - Phone:817-437-7622
Mailing Address - Fax:
Practice Address - Street 1:5601 BRIDGE ST
Practice Address - Street 2:SUITE 490
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76112-2384
Practice Address - Country:US
Practice Address - Phone:817-446-5000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-10-20
Last Update Date:2010-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX104202235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist