Provider Demographics
NPI:1568877066
Name:AREVALO GARZA, ANGELICA (MA, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:ANGELICA
Middle Name:
Last Name:AREVALO GARZA
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1217 W. HOUSTON AVE
Mailing Address - Street 2:
Mailing Address - City:MCALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:78501-5012
Mailing Address - Country:US
Mailing Address - Phone:956-631-9171
Mailing Address - Fax:956-631-7566
Practice Address - Street 1:2422 E TYLER AVE # C
Practice Address - Street 2:
Practice Address - City:HARLINGEN
Practice Address - State:TX
Practice Address - Zip Code:78550
Practice Address - Country:US
Practice Address - Phone:956-423-9171
Practice Address - Fax:956-423-7457
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-24
Last Update Date:2019-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX108934235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX3977167-01Medicaid