Provider Demographics
NPI:1851537856
Name:CANTU, MONIQUE L (ASST SLP)
Entity Type:Individual
Prefix:MISS
First Name:MONIQUE
Middle Name:L
Last Name:CANTU
Suffix:
Gender:F
Credentials:ASST SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1228 S GUMWOOD ST
Mailing Address - Street 2:
Mailing Address - City:PHARR
Mailing Address - State:TX
Mailing Address - Zip Code:78577-6022
Mailing Address - Country:US
Mailing Address - Phone:956-783-0854
Mailing Address - Fax:956-262-7756
Practice Address - Street 1:205 W EDINBURG AVE
Practice Address - Street 2:
Practice Address - City:ELSA
Practice Address - State:TX
Practice Address - Zip Code:78543-1769
Practice Address - Country:US
Practice Address - Phone:956-262-1037
Practice Address - Fax:956-262-7756
Is Sole Proprietor?:No
Enumeration Date:2008-12-22
Last Update Date:2008-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX347392355S0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX183477202Medicaid
TX454880Medicare Oscar/Certification