Provider Demographics
NPI:1245386994
Name:MENDOZA, LILLIAN ANDREA (SLP)
Entity Type:Individual
Prefix:
First Name:LILLIAN
Middle Name:ANDREA
Last Name:MENDOZA
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2611 AILANI CIR
Mailing Address - Street 2:
Mailing Address - City:HARLINGEN
Mailing Address - State:TX
Mailing Address - Zip Code:78552-3373
Mailing Address - Country:US
Mailing Address - Phone:956-244-6228
Mailing Address - Fax:956-425-6499
Practice Address - Street 1:2611 AILANI CIR
Practice Address - Street 2:
Practice Address - City:HARLINGEN
Practice Address - State:TX
Practice Address - Zip Code:78552-3373
Practice Address - Country:US
Practice Address - Phone:956-244-6228
Practice Address - Fax:956-425-6499
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-26
Last Update Date:2012-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX101847235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX101847OtherLICENSE
TX272423093OtherEIN