Provider Demographics
NPI:1508382516
Name:VASQUEZ, DOMINIQUE JAGELKA (MS, CCC-SLP)
Entity type:Individual
Prefix:
First Name:DOMINIQUE
Middle Name:JAGELKA
Last Name:VASQUEZ
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1966 INWOOD RD
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75235-7205
Mailing Address - Country:US
Mailing Address - Phone:972-883-3030
Mailing Address - Fax:
Practice Address - Street 1:1966 INWOOD RD
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75235-7205
Practice Address - Country:US
Practice Address - Phone:972-883-3030
Practice Address - Fax:972-883-3022
Is Sole Proprietor?:No
Enumeration Date:2017-08-21
Last Update Date:2024-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX118443235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist