Provider Demographics
NPI:1619492675
Name:VALDEZ, JESSICA LUCIA (SLP CFY)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:LUCIA
Last Name:VALDEZ
Suffix:
Gender:F
Credentials:SLP CFY
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8903 HERON NEST DR
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77064-4380
Mailing Address - Country:US
Mailing Address - Phone:805-291-6961
Mailing Address - Fax:
Practice Address - Street 1:4718 HALLMARK DR
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77056
Practice Address - Country:US
Practice Address - Phone:713-622-6633
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-08-10
Last Update Date:2018-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA27247235Z00000X
CA11747235Z00000X
TX114656235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist