Provider Demographics
NPI:1154012938
Name:CONATSER, AVERI (SLP-CCC)
Entity type:Individual
Prefix:
First Name:AVERI
Middle Name:
Last Name:CONATSER
Suffix:
Gender:F
Credentials:SLP-CCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2129 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:TAHOKA
Mailing Address - State:TX
Mailing Address - Zip Code:79373-5323
Mailing Address - Country:US
Mailing Address - Phone:806-561-4105
Mailing Address - Fax:
Practice Address - Street 1:2129 N MAIN ST
Practice Address - Street 2:
Practice Address - City:TAHOKA
Practice Address - State:TX
Practice Address - Zip Code:79373-5323
Practice Address - Country:US
Practice Address - Phone:806-561-4105
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-15
Last Update Date:2025-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX119464235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX119464OtherTEXAS DEPARTMENT OF LICENSING & REGULATION