Provider Demographics
NPI:1609543990
Name:BALDERAS, ROXANNA (BS SLP-ASSISTANT)
Entity Type:Individual
Prefix:
First Name:ROXANNA
Middle Name:
Last Name:BALDERAS
Suffix:
Gender:F
Credentials:BS SLP-ASSISTANT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2512 E LA POINTE AVE
Mailing Address - Street 2:
Mailing Address - City:ALTON
Mailing Address - State:TX
Mailing Address - Zip Code:78573-0888
Mailing Address - Country:US
Mailing Address - Phone:956-445-2124
Mailing Address - Fax:
Practice Address - Street 1:800 S 16TH 1/2 ST STE 20
Practice Address - Street 2:
Practice Address - City:MCALLEN
Practice Address - State:TX
Practice Address - Zip Code:78501-5263
Practice Address - Country:US
Practice Address - Phone:956-328-5424
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-25
Last Update Date:2021-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX360132355S0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language AssistantGroup - Single Specialty