Provider Demographics
NPI:1427479245
Name:FONTALVO, AMALIA DE JESUS (MS)
Entity type:Individual
Prefix:
First Name:AMALIA
Middle Name:DE JESUS
Last Name:FONTALVO
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5015 LOUETTA RD
Mailing Address - Street 2:#732
Mailing Address - City:SPRING
Mailing Address - State:TX
Mailing Address - Zip Code:77379-8163
Mailing Address - Country:US
Mailing Address - Phone:908-494-8564
Mailing Address - Fax:
Practice Address - Street 1:5015 LOUETTA RD
Practice Address - Street 2:#732
Practice Address - City:SPRING
Practice Address - State:TX
Practice Address - Zip Code:77379
Practice Address - Country:US
Practice Address - Phone:908-494-8564
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-12-20
Last Update Date:2022-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX108360235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist