Provider Demographics
NPI:1700119872
Name:FONTENETTE, DENIEDRA (MS CCC-SLP)
Entity Type:Individual
Prefix:MS
First Name:DENIEDRA
Middle Name:
Last Name:FONTENETTE
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 1:3841 KAREN RD
Mailing Address - Street 2:
Mailing Address - City:MIDLOTHIAN
Mailing Address - State:TX
Mailing Address - Zip Code:76065-2362
Mailing Address - Country:US
Mailing Address - Phone:817-798-9040
Mailing Address - Fax:
Practice Address - Street 1:3841 KAREN RD
Practice Address - Street 2:
Practice Address - City:MIDLOTHIAN
Practice Address - State:TX
Practice Address - Zip Code:76065-2362
Practice Address - Country:US
Practice Address - Phone:817-798-9040
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-08
Last Update Date:2022-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX100910235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist