Provider Demographics
NPI:1942575394
Name:BALTIERREZ, VANESSA TABETHA
Entity Type:Individual
Prefix:MISS
First Name:VANESSA
Middle Name:TABETHA
Last Name:BALTIERREZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8370 WESTVIEW DR APT 6A
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77055-6704
Mailing Address - Country:US
Mailing Address - Phone:713-444-1861
Mailing Address - Fax:
Practice Address - Street 1:11777 KATY FWY STE 260
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77079-1776
Practice Address - Country:US
Practice Address - Phone:281-558-5437
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-03-19
Last Update Date:2012-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX357122355S0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant