Provider Demographics
NPI:1760620793
Name:DREYER, VIRGINIA GAYLE (CCC-SLP)
Entity Type:Individual
Prefix:
First Name:VIRGINIA
Middle Name:GAYLE
Last Name:DREYER
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 1:60 RANCH HOUSE LOOP
Mailing Address - Street 2:
Mailing Address - City:ANGLETON
Mailing Address - State:TX
Mailing Address - Zip Code:77515-2723
Mailing Address - Country:US
Mailing Address - Phone:979-900-8825
Mailing Address - Fax:
Practice Address - Street 1:60 RANCH HOUSE LOOP
Practice Address - Street 2:
Practice Address - City:ANGLETON
Practice Address - State:TX
Practice Address - Zip Code:77515-2723
Practice Address - Country:US
Practice Address - Phone:979-900-8825
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-29
Last Update Date:2022-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX104098235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN23Medicaid
IN23Medicare UPIN
IN23Medicare PIN