Provider Demographics
NPI:1194943647
Name:SANDOVAL, VANESSA LEE (MS CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:VANESSA
Middle Name:LEE
Last Name:SANDOVAL
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 1:501 7TH ST
Mailing Address - Street 2:
Mailing Address - City:WOLFFORTH
Mailing Address - State:TX
Mailing Address - Zip Code:79382-2934
Mailing Address - Country:US
Mailing Address - Phone:806-866-9541
Mailing Address - Fax:806-866-4135
Practice Address - Street 1:501 7TH ST
Practice Address - Street 2:
Practice Address - City:WOLFFORTH
Practice Address - State:TX
Practice Address - Zip Code:79382-2934
Practice Address - Country:US
Practice Address - Phone:806-866-9541
Practice Address - Fax:806-866-4135
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-22
Last Update Date:2014-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX101192235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX178622001Medicaid