Provider Demographics
NPI:1790924538
Name:FORERO, MARIA DELAGARZA (CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:MARIA
Middle Name:DELAGARZA
Last Name:FORERO
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 1:705 E 43RD ST
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78751-3912
Mailing Address - Country:US
Mailing Address - Phone:512-577-7057
Mailing Address - Fax:
Practice Address - Street 1:705 E 43RD ST
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78751-3912
Practice Address - Country:US
Practice Address - Phone:512-577-7057
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-18
Last Update Date:2022-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX13804260235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX9876543210AMedicaid