Provider Demographics
NPI:1407132384
Name:JUAREZ, LIZZET
Entity Type:Individual
Prefix:
First Name:LIZZET
Middle Name:
Last Name:JUAREZ
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 1:3507 LOOP 20
Mailing Address - Street 2:SUITE 7A
Mailing Address - City:LAREDO
Mailing Address - State:TX
Mailing Address - Zip Code:78043
Mailing Address - Country:US
Mailing Address - Phone:956-753-5600
Mailing Address - Fax:956-753-5602
Practice Address - Street 1:3507 LOOP 20
Practice Address - Street 2:SUITE 7A
Practice Address - City:LAREDO
Practice Address - State:TX
Practice Address - Zip Code:78043
Practice Address - Country:US
Practice Address - Phone:956-753-5600
Practice Address - Fax:956-753-5602
Is Sole Proprietor?:No
Enumeration Date:2011-10-24
Last Update Date:2011-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX353672355S0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX35367OtherSTATE LICENSE