Provider Demographics
NPI:1255623161
Name:HERNANDEZ, ELIZABETH R (SLP)
Entity type:Individual
Prefix:MS
First Name:ELIZABETH
Middle Name:R
Last Name:HERNANDEZ
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2404 AMBASSADOR ST.
Mailing Address - Street 2:
Mailing Address - City:EDINBURG
Mailing Address - State:TX
Mailing Address - Zip Code:78541
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1315 W. MAIN A, SUITE 11
Practice Address - Street 2:
Practice Address - City:ALTON
Practice Address - State:TX
Practice Address - Zip Code:78573
Practice Address - Country:US
Practice Address - Phone:956-580-1100
Practice Address - Fax:956-580-1138
Is Sole Proprietor?:No
Enumeration Date:2011-05-11
Last Update Date:2019-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX106202235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist