Provider Demographics
NPI:1952554719
Name:RALLIS, VERONICA E (MS, CCC-SLP)
Entity type:Individual
Prefix:
First Name:VERONICA
Middle Name:E
Last Name:RALLIS
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 1:6768 DIAMOND RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79912-7621
Mailing Address - Country:US
Mailing Address - Phone:915-373-1092
Mailing Address - Fax:866-830-3399
Practice Address - Street 1:6768 DIAMOND RIDGE DR
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79912-7621
Practice Address - Country:US
Practice Address - Phone:915-373-1092
Practice Address - Fax:866-830-3399
Is Sole Proprietor?:No
Enumeration Date:2008-10-24
Last Update Date:2008-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX19745235Z00000X
NM4445235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist