Provider Demographics
NPI:1790562098
Name:TAFOLLA, DEIDRA DENISE (SLP)
Entity Type:Individual
Prefix:MS
First Name:DEIDRA
Middle Name:DENISE
Last Name:TAFOLLA
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 1:5006 E EXPRESSWAY 83 UNIT B
Mailing Address - Street 2:
Mailing Address - City:MERCEDES
Mailing Address - State:TX
Mailing Address - Zip Code:78570-5009
Mailing Address - Country:US
Mailing Address - Phone:956-565-9300
Mailing Address - Fax:956-565-9686
Practice Address - Street 1:327 W 3RD ST
Practice Address - Street 2:
Practice Address - City:MERCEDES
Practice Address - State:TX
Practice Address - Zip Code:78570-3105
Practice Address - Country:US
Practice Address - Phone:956-565-9300
Practice Address - Fax:956-565-9686
Is Sole Proprietor?:No
Enumeration Date:2023-09-11
Last Update Date:2024-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX121723235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist