Provider Demographics
NPI:1619422318
Name:ACQUAVIVA, ANNALISA (MS SLP-CFY)
Entity Type:Individual
Prefix:
First Name:ANNALISA
Middle Name:
Last Name:ACQUAVIVA
Suffix:
Gender:F
Credentials:MS SLP-CFY
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6800 GATEWAY BLVD E
Mailing Address - Street 2:BLDG 4A
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79915-1040
Mailing Address - Country:US
Mailing Address - Phone:915-779-7827
Mailing Address - Fax:915-779-7829
Practice Address - Street 1:6800 GATEWAY BLVD E
Practice Address - Street 2:BLDG 4A
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79915-1040
Practice Address - Country:US
Practice Address - Phone:915-779-7827
Practice Address - Fax:915-779-7829
Is Sole Proprietor?:No
Enumeration Date:2016-08-23
Last Update Date:2016-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX112627235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist