Provider Demographics
NPI:1285917245
Name:CAVAZOS, GLORIA IMELDA (SLP)
Entity type:Individual
Prefix:
First Name:GLORIA
Middle Name:IMELDA
Last Name:CAVAZOS
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7010 NW 100 DR
Mailing Address - Street 2:A104
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77092-2052
Mailing Address - Country:US
Mailing Address - Phone:713-462-6060
Mailing Address - Fax:713-462-6066
Practice Address - Street 1:7010 NW 100 DR
Practice Address - Street 2:A104
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77092-2052
Practice Address - Country:US
Practice Address - Phone:713-462-6060
Practice Address - Fax:713-462-6066
Is Sole Proprietor?:No
Enumeration Date:2011-09-26
Last Update Date:2011-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX103436235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist