Provider Demographics
NPI:1447572946
Name:MASS, VANESSA (MS SLP)
Entity Type:Individual
Prefix:
First Name:VANESSA
Middle Name:
Last Name:MASS
Suffix:
Gender:F
Credentials:MS SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12514 PIERSON HOLLOW DR
Mailing Address - Street 2:
Mailing Address - City:HUMBLE
Mailing Address - State:TX
Mailing Address - Zip Code:77346-4265
Mailing Address - Country:US
Mailing Address - Phone:787-459-6598
Mailing Address - Fax:
Practice Address - Street 1:CC16 CALLE 18
Practice Address - Street 2:
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00957-4359
Practice Address - Country:US
Practice Address - Phone:787-459-6598
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-24
Last Update Date:2023-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR830235Z00000X
TX112338235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist