Provider Demographics
NPI:1235360967
Name:FONTANEZ, DENISSE (MS, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:DENISSE
Middle Name:
Last Name:FONTANEZ
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:URB VILLAS DE RIO GRANDE
Mailing Address - Street 2:CALLE GARCIA DE LA NOCEDA B-18
Mailing Address - City:RIO GRANDE
Mailing Address - State:PR
Mailing Address - Zip Code:00745
Mailing Address - Country:US
Mailing Address - Phone:787-887-2555
Mailing Address - Fax:
Practice Address - Street 1:URB VILLAS DE RIO GRANDE
Practice Address - Street 2:CALLE GARCIA DE LA NOCEDA B-18
Practice Address - City:RIO GRANDE
Practice Address - State:PR
Practice Address - Zip Code:00745
Practice Address - Country:US
Practice Address - Phone:787-887-2555
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-29
Last Update Date:2014-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR668235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR668OtherPROFFESIONAL LICENSE