Provider Demographics
NPI:1013319557
Name:CHAVEZ, DEANNA DECKER (MA-CCC/SLP)
Entity type:Individual
Prefix:
First Name:DEANNA
Middle Name:DECKER
Last Name:CHAVEZ
Suffix:
Gender:F
Credentials:MA-CCC/SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:224 ODESSA DR
Mailing Address - Street 2:
Mailing Address - City:HASLET
Mailing Address - State:TX
Mailing Address - Zip Code:76052-4015
Mailing Address - Country:US
Mailing Address - Phone:972-872-0709
Mailing Address - Fax:
Practice Address - Street 1:190 CIVIC CIR STE 250
Practice Address - Street 2:
Practice Address - City:LEWISVILLE
Practice Address - State:TX
Practice Address - Zip Code:75067-3648
Practice Address - Country:US
Practice Address - Phone:972-219-1200
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-16
Last Update Date:2014-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX104652235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist