Provider Demographics
NPI:1225274251
Name:PEREZ, VANESSA MENDEZ (MS CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:VANESSA
Middle Name:MENDEZ
Last Name:PEREZ
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 1:2508 WAGNER CT
Mailing Address - Street 2:
Mailing Address - City:MISSION
Mailing Address - State:TX
Mailing Address - Zip Code:78574-4625
Mailing Address - Country:US
Mailing Address - Phone:956-369-9633
Mailing Address - Fax:
Practice Address - Street 1:5006 E EXPRESSWAY 83
Practice Address - Street 2:STE. B
Practice Address - City:MERCEDES
Practice Address - State:TX
Practice Address - Zip Code:78570-5008
Practice Address - Country:US
Practice Address - Phone:956-565-9300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-12-22
Last Update Date:2021-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX105052235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX183477202Medicaid
TX454880Medicare Oscar/Certification