Provider Demographics
NPI:1720281413
Name:VASQUEZ, MELISSA A (SLP)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:A
Last Name:VASQUEZ
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 1:9901 WOODY DR
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79925-5414
Mailing Address - Country:US
Mailing Address - Phone:915-256-8488
Mailing Address - Fax:
Practice Address - Street 1:2201 N CAMINO PRINCIPAL
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85715-5320
Practice Address - Country:US
Practice Address - Phone:520-300-5585
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-08
Last Update Date:2009-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX103371235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist