Provider Demographics
NPI:1295220838
Name:MENCHACA, JUAN MANUEL JR
Entity Type:Individual
Prefix:
First Name:JUAN
Middle Name:MANUEL
Last Name:MENCHACA
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2600 GESSNER RD STE 190
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77080-3844
Mailing Address - Country:US
Mailing Address - Phone:713-996-7996
Mailing Address - Fax:
Practice Address - Street 1:2600 GESSNER RD STE 190
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77080-3844
Practice Address - Country:US
Practice Address - Phone:713-996-7996
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-26
Last Update Date:2018-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX113982235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist