Provider Demographics
NPI:1942879762
Name:MENDOZA, VICKIE VEL
Entity Type:Individual
Prefix:
First Name:VICKIE
Middle Name:VEL
Last Name:MENDOZA
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 1:4000 N US HIGHWAY 83
Mailing Address - Street 2:
Mailing Address - City:CRYSTAL CITY
Mailing Address - State:TX
Mailing Address - Zip Code:78839-1615
Mailing Address - Country:US
Mailing Address - Phone:956-722-6221
Mailing Address - Fax:956-722-6275
Practice Address - Street 1:4000 N US HIGHWAY 83
Practice Address - Street 2:
Practice Address - City:CRYSTAL CITY
Practice Address - State:TX
Practice Address - Zip Code:78839-1615
Practice Address - Country:US
Practice Address - Phone:956-722-6221
Practice Address - Fax:956-722-6275
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-24
Last Update Date:2021-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX419402355S0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX41940OtherSLPA