Provider Demographics
NPI:1912786328
Name:ACEVEDO, EMERESS MACKENZIE (MS CF-SLP)
Entity Type:Individual
Prefix:MS
First Name:EMERESS
Middle Name:MACKENZIE
Last Name:ACEVEDO
Suffix:
Gender:F
Credentials:MS CF-SLP
Other - Prefix:
Other - First Name:EMERESS
Other - Middle Name:MACKENZIE
Other - Last Name:ACEVEDO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:201 AVONDALE ST
Mailing Address - Street 2:
Mailing Address - City:DEL RIO
Mailing Address - State:TX
Mailing Address - Zip Code:78840-3003
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:132 FOSTER DR
Practice Address - Street 2:
Practice Address - City:DEL RIO
Practice Address - State:TX
Practice Address - Zip Code:78840-2608
Practice Address - Country:US
Practice Address - Phone:830-774-1156
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-25
Last Update Date:2023-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX120917235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist