Provider Demographics
NPI:1952479040
Name:REEVES, IRIS SUSAN (CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:IRIS
Middle Name:SUSAN
Last Name:REEVES
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:MRS
Other - First Name:SUSAN
Other - Middle Name:
Other - Last Name:REEVES
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:105 WESTLAND ST
Mailing Address - Street 2:
Mailing Address - City:SAN ANGELO
Mailing Address - State:TX
Mailing Address - Zip Code:76901-3051
Mailing Address - Country:US
Mailing Address - Phone:325-340-4020
Mailing Address - Fax:325-617-7809
Practice Address - Street 1:105 WESTLAND ST
Practice Address - Street 2:
Practice Address - City:SAN ANGELO
Practice Address - State:TX
Practice Address - Zip Code:76901-3051
Practice Address - Country:US
Practice Address - Phone:325-340-4020
Practice Address - Fax:325-617-7809
Is Sole Proprietor?:No
Enumeration Date:2006-11-30
Last Update Date:2018-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM5524235Z00000X
TX10764235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX004958702Medicaid