Provider Demographics
NPI:1710626494
Name:ARZOLA, DOMINIQUE ROSE (MS, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:DOMINIQUE
Middle Name:ROSE
Last Name:ARZOLA
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4715 CRESTED ROCK DR
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78217-1551
Mailing Address - Country:US
Mailing Address - Phone:512-922-7593
Mailing Address - Fax:
Practice Address - Street 1:7 UPPER BALCONES RD
Practice Address - Street 2:
Practice Address - City:BOERNE
Practice Address - State:TX
Practice Address - Zip Code:78006-8546
Practice Address - Country:US
Practice Address - Phone:210-306-1662
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-01
Last Update Date:2022-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX117089235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist