Provider Demographics
NPI:1508094822
Name:VAZQUEZ, VERUSHKA M (MS, CCC-SLP)
Entity Type:Individual
Prefix:MISS
First Name:VERUSHKA
Middle Name:M
Last Name:VAZQUEZ
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 1:4325 EGRET DR
Mailing Address - Street 2:
Mailing Address - City:SEABROOK
Mailing Address - State:TX
Mailing Address - Zip Code:77586-2566
Mailing Address - Country:US
Mailing Address - Phone:832-208-5889
Mailing Address - Fax:832-558-6926
Practice Address - Street 1:4325 EGRET DR
Practice Address - Street 2:
Practice Address - City:SEABROOK
Practice Address - State:TX
Practice Address - Zip Code:77586-2566
Practice Address - Country:US
Practice Address - Phone:832-208-5889
Practice Address - Fax:832-558-6926
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-25
Last Update Date:2022-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX105056235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX280216701Medicaid