Provider Demographics
NPI:1902230162
Name:MONTOYA, VANESSA DOLORES (MS, CCC-SLP)
Entity Type:Individual
Prefix:MS
First Name:VANESSA
Middle Name:DOLORES
Last Name:MONTOYA
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4200 HILLCREST DR APT 110
Mailing Address - Street 2:
Mailing Address - City:HOLLYWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:33021-7935
Mailing Address - Country:US
Mailing Address - Phone:509-630-9575
Mailing Address - Fax:
Practice Address - Street 1:4200 HILLCREST DR APT 110
Practice Address - Street 2:
Practice Address - City:HOLLYWOOD
Practice Address - State:FL
Practice Address - Zip Code:33021-7935
Practice Address - Country:US
Practice Address - Phone:509-630-9575
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-08-23
Last Update Date:2013-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA 12027235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist