Provider Demographics
NPI:1376672600
Name:MENCHACA, GLORIA ANN (SLP)
Entity Type:Individual
Prefix:MS
First Name:GLORIA
Middle Name:ANN
Last Name:MENCHACA
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 1:731 W COTTAGE ST
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77009-6107
Mailing Address - Country:US
Mailing Address - Phone:713-861-6793
Mailing Address - Fax:
Practice Address - Street 1:731 W COTTAGE ST
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77009-6107
Practice Address - Country:US
Practice Address - Phone:713-861-6793
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-04
Last Update Date:2008-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX19211235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist