Provider Demographics
NPI:1932698198
Name:VASQUEZ, MARRISA CRUZ (SLPA)
Entity Type:Individual
Prefix:
First Name:MARRISA
Middle Name:CRUZ
Last Name:VASQUEZ
Suffix:
Gender:F
Credentials:SLPA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1571 W DEL RIO ST
Mailing Address - Street 2:
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85224-6964
Mailing Address - Country:US
Mailing Address - Phone:480-291-4680
Mailing Address - Fax:
Practice Address - Street 1:2950 N DOBSON RD STE 3
Practice Address - Street 2:
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85224-1819
Practice Address - Country:US
Practice Address - Phone:489-935-0614
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-03
Last Update Date:2018-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZSLPA110682355S0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZSLPA11068OtherARIZONA DEPARTMENT OF HEALTH SERVICES