Provider Demographics
NPI:1326252909
Name:HERRERAS MERCADO, RAUL (CLINSCD, MBE,CCC-SLP)
Entity Type:Individual
Prefix:
First Name:RAUL
Middle Name:
Last Name:HERRERAS MERCADO
Suffix:
Gender:M
Credentials:CLINSCD, MBE,CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3101 W. MCDOWELL ROAD
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85009
Mailing Address - Country:US
Mailing Address - Phone:602-442-2999
Mailing Address - Fax:
Practice Address - Street 1:1900 N OREGON ST STE 100
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79902-3333
Practice Address - Country:US
Practice Address - Phone:915-533-1388
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-10
Last Update Date:2021-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZSLPL5367235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist