Provider Demographics
NPI:1194149039
Name:ESQUIVEL, IRENE (MS, CCC-SLP)
Entity type:Individual
Prefix:
First Name:IRENE
Middle Name:
Last Name:ESQUIVEL
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 1:1811 PACK SADDLE ST
Mailing Address - Street 2:
Mailing Address - City:OAKDALE
Mailing Address - State:CA
Mailing Address - Zip Code:95361-8254
Mailing Address - Country:US
Mailing Address - Phone:209-581-8321
Mailing Address - Fax:
Practice Address - Street 1:1811 PACK SADDLE ST
Practice Address - Street 2:
Practice Address - City:OAKDALE
Practice Address - State:CA
Practice Address - Zip Code:95361-8254
Practice Address - Country:US
Practice Address - Phone:209-581-8321
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-02-12
Last Update Date:2014-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CASP20582235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist