Provider Demographics
NPI:1306195623
Name:BARRAZA-DERDA, ANNA
Entity Type:Individual
Prefix:
First Name:ANNA
Middle Name:
Last Name:BARRAZA-DERDA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:901 WALLACE BLVD
Mailing Address - Street 2:
Mailing Address - City:AMARILLO
Mailing Address - State:TX
Mailing Address - Zip Code:79106-1705
Mailing Address - Country:US
Mailing Address - Phone:806-677-2126
Mailing Address - Fax:806-359-0506
Practice Address - Street 1:901 WALLACE BLVD
Practice Address - Street 2:
Practice Address - City:AMARILLO
Practice Address - State:TX
Practice Address - Zip Code:79106-1705
Practice Address - Country:US
Practice Address - Phone:806-677-2126
Practice Address - Fax:806-359-0506
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-31
Last Update Date:2015-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX106277235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX149984001Medicaid
TX207164901Medicaid
TX149984001Medicaid
TX676535Medicare PIN