Provider Demographics
NPI:1932811650
Name:URSERY, SHATEQUA KEIRRA (SLP-A)
Entity Type:Individual
Prefix:
First Name:SHATEQUA
Middle Name:KEIRRA
Last Name:URSERY
Suffix:
Gender:F
Credentials:SLP-A
Other - Prefix:
Other - First Name:SHATEQUA
Other - Middle Name:KEIRRA
Other - Last Name:GAMBLE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1056 NEPAL SKY STREET
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79928
Mailing Address - Country:US
Mailing Address - Phone:803-212-8379
Mailing Address - Fax:
Practice Address - Street 1:2114 N ZARAGOZA RD
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79938-8122
Practice Address - Country:US
Practice Address - Phone:915-271-8030
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-12-14
Last Update Date:2022-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX429332355S0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language AssistantGroup - Multi-Specialty