Provider Demographics
NPI:1275288953
Name:CALDERON, ADRIANA (SLPA)
Entity Type:Individual
Prefix:
First Name:ADRIANA
Middle Name:
Last Name:CALDERON
Suffix:
Gender:F
Credentials:SLPA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3306 S JENNINGS AVE
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76110-4023
Mailing Address - Country:US
Mailing Address - Phone:682-234-2207
Mailing Address - Fax:
Practice Address - Street 1:2401 DENALI CT
Practice Address - Street 2:
Practice Address - City:MANSFIELD
Practice Address - State:TX
Practice Address - Zip Code:76063-1858
Practice Address - Country:US
Practice Address - Phone:401-537-4471
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-02-21
Last Update Date:2022-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX42236235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist