Provider Demographics
NPI:1336357722
Name:KRETZ, CLARISSA G (MA,CCC-SLP)
Entity type:Individual
Prefix:
First Name:CLARISSA
Middle Name:G
Last Name:KRETZ
Suffix:
Gender:F
Credentials:MA,CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:28175 CANELO LOOP
Mailing Address - Street 2:
Mailing Address - City:RIO HONDO
Mailing Address - State:TX
Mailing Address - Zip Code:78583-3502
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2117 E TYLER AVE STE B
Practice Address - Street 2:
Practice Address - City:HARLINGEN
Practice Address - State:TX
Practice Address - Zip Code:78550-7211
Practice Address - Country:US
Practice Address - Phone:956-440-0580
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-18
Last Update Date:2008-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX102257235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist