Provider Demographics
NPI:1659449734
Name:VELASCO, DORIS PHIPPEN (MS CCC-A)
Entity Type:Individual
Prefix:MRS
First Name:DORIS
Middle Name:PHIPPEN
Last Name:VELASCO
Suffix:
Gender:F
Credentials:MS CCC-A
Other - Prefix:MS
Other - First Name:DORIS
Other - Middle Name:P
Other - Last Name:VELASCO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MS CCC-A
Mailing Address - Street 1:673 MERCHANT ST STE B
Mailing Address - Street 2:
Mailing Address - City:VACAVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95688-6952
Mailing Address - Country:US
Mailing Address - Phone:707-446-0742
Mailing Address - Fax:
Practice Address - Street 1:673 MERCHANT ST STE B
Practice Address - Street 2:
Practice Address - City:VACAVILLE
Practice Address - State:CA
Practice Address - Zip Code:95688-6952
Practice Address - Country:US
Practice Address - Phone:707-446-0742
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-30
Last Update Date:2022-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAU 1240231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist