Provider Demographics
NPI:1598911919
Name:DOMINGUEZ, VERONICA M (MA, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:VERONICA
Middle Name:M
Last Name:DOMINGUEZ
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:VERONICA
Other - Middle Name:M
Other - Last Name:ACOSTA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA, CCC-SLP
Mailing Address - Street 1:11513 W AMBER STONE DR
Mailing Address - Street 2:
Mailing Address - City:MARANA
Mailing Address - State:AZ
Mailing Address - Zip Code:85653-8107
Mailing Address - Country:US
Mailing Address - Phone:520-954-0358
Mailing Address - Fax:
Practice Address - Street 1:11513 W AMBER STONE DR
Practice Address - Street 2:
Practice Address - City:MARANA
Practice Address - State:AZ
Practice Address - Zip Code:85653-8107
Practice Address - Country:US
Practice Address - Phone:520-954-0358
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-08-18
Last Update Date:2015-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZTSLP5951235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist