Provider Demographics
NPI:1386836419
Name:KAYQUAPTEWA, DORCAS MINA (MS, CCC-SLP)
Entity Type:Individual
Prefix:MISS
First Name:DORCAS
Middle Name:MINA
Last Name:KAYQUAPTEWA
Suffix:
Gender:F
Credentials:MS, 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:P.O. BOX 668
Mailing Address - Street 2:
Mailing Address - City:HOLBROOK
Mailing Address - State:AZ
Mailing Address - Zip Code:86025
Mailing Address - Country:US
Mailing Address - Phone:928-524-2123
Mailing Address - Fax:928-697-2095
Practice Address - Street 1:NORTH HIGHWAY 163
Practice Address - Street 2:
Practice Address - City:KAYENTA
Practice Address - State:AZ
Practice Address - Zip Code:86033-0337
Practice Address - Country:US
Practice Address - Phone:928-697-2051
Practice Address - Fax:928-697-2095
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-13
Last Update Date:2014-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
2355S0801X
AZSLP5766235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
No2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant