Provider Demographics
NPI:1336758010
Name:PATEL, DEEPALI (MA CCC-SLP)
Entity Type:Individual
Prefix:MS
First Name:DEEPALI
Middle Name:
Last Name:PATEL
Suffix:
Gender:F
Credentials:MA CCC-SLP
Other - Prefix:
Other - First Name:DEEPA
Other - Middle Name:
Other - Last Name:PATEL
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MA CCC- SLP
Mailing Address - Street 1:2931 BERING DR
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77057-5705
Mailing Address - Country:US
Mailing Address - Phone:361-728-3751
Mailing Address - Fax:
Practice Address - Street 1:2931 BERING DR
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77057-5705
Practice Address - Country:US
Practice Address - Phone:361-728-3751
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-28
Last Update Date:2020-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX100046235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX100046OtherTEXAS STATE BOARD FOR SPEECH LANGUAGE PATHOLOGY AND AUDIOLOGY