Provider Demographics
NPI:1952704108
Name:IZAGUIRRE, LUCERITO CARRILLO (BS SLP-ASSISTANT)
Entity Type:Individual
Prefix:MRS
First Name:LUCERITO
Middle Name:CARRILLO
Last Name:IZAGUIRRE
Suffix:
Gender:F
Credentials:BS SLP-ASSISTANT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6666 HARWIN DR STE 490
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77036-2275
Mailing Address - Country:US
Mailing Address - Phone:713-429-1176
Mailing Address - Fax:832-252-9263
Practice Address - Street 1:6666 HARWIN DR STE 490
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77036-2275
Practice Address - Country:US
Practice Address - Phone:713-429-1176
Practice Address - Fax:832-252-9263
Is Sole Proprietor?:No
Enumeration Date:2014-10-02
Last Update Date:2014-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX383142355S0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant