Provider Demographics
NPI:1124501796
Name:CANTU, YADIRA (SLPD, CCC-SLP)
Entity type:Individual
Prefix:
First Name:YADIRA
Middle Name:
Last Name:CANTU
Suffix:
Gender:F
Credentials:SLPD, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1621 W B ST
Mailing Address - Street 2:
Mailing Address - City:MISSION
Mailing Address - State:TX
Mailing Address - Zip Code:78572-0075
Mailing Address - Country:US
Mailing Address - Phone:956-560-8038
Mailing Address - Fax:
Practice Address - Street 1:1621 W B ST
Practice Address - Street 2:
Practice Address - City:MISSION
Practice Address - State:TX
Practice Address - Zip Code:78572-0075
Practice Address - Country:US
Practice Address - Phone:281-849-4241
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-10
Last Update Date:2024-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX107718235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist