Provider Demographics
NPI:1689710428
Name:DELAGARZA, CLARISSA (SLP)
Entity Type:Individual
Prefix:
First Name:CLARISSA
Middle Name:
Last Name:DELAGARZA
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2335 E SAUNDERS ST
Mailing Address - Street 2:SUITE 3
Mailing Address - City:LAREDO
Mailing Address - State:TX
Mailing Address - Zip Code:78041-5434
Mailing Address - Country:US
Mailing Address - Phone:956-791-4800
Mailing Address - Fax:956-791-4422
Practice Address - Street 1:2335 E SAUNDERS ST
Practice Address - Street 2:SUITE 3
Practice Address - City:LAREDO
Practice Address - State:TX
Practice Address - Zip Code:78041-5434
Practice Address - Country:US
Practice Address - Phone:956-791-4800
Practice Address - Fax:956-791-4422
Is Sole Proprietor?:No
Enumeration Date:2007-01-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX24184235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX24184OtherLICENSE