Provider Demographics
NPI:1770610586
Name:VALLEJO, ANA S (SLP-CCC)
Entity type:Individual
Prefix:
First Name:ANA
Middle Name:S
Last Name:VALLEJO
Suffix:
Gender:F
Credentials:SLP-CCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:413 E 11TH ST
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:TX
Mailing Address - Zip Code:78589-5174
Mailing Address - Country:US
Mailing Address - Phone:956-467-6312
Mailing Address - Fax:
Practice Address - Street 1:305 NE LOOP 820 BUSINESS TOWER 1
Practice Address - Street 2:SUITE 100
Practice Address - City:HURST
Practice Address - State:TX
Practice Address - Zip Code:76053
Practice Address - Country:US
Practice Address - Phone:817-292-8787
Practice Address - Fax:817-789-6849
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-28
Last Update Date:2015-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX101818235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist