Provider Demographics
NPI:1750667044
Name:BAUTISTA, VERONICA (CCC-SLP)
Entity Type:Individual
Prefix:
First Name:VERONICA
Middle Name:
Last Name:BAUTISTA
Suffix:
Gender:F
Credentials: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:PO BOX 3113
Mailing Address - Street 2:
Mailing Address - City:ANTHONY
Mailing Address - State:NM
Mailing Address - Zip Code:88021-3113
Mailing Address - Country:US
Mailing Address - Phone:915-478-7468
Mailing Address - Fax:
Practice Address - Street 1:840 6TH ST
Practice Address - Street 2:
Practice Address - City:ANTHONY
Practice Address - State:TX
Practice Address - Zip Code:79821-7124
Practice Address - Country:US
Practice Address - Phone:915-478-7468
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-10-31
Last Update Date:2022-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM4829235Z00000X
TX113340235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist