Provider Demographics
NPI:1962163568
Name:FERNANDEZ-VIVAR, VANESSA EILEEN (MS,CCC)
Entity type:Individual
Prefix:
First Name:VANESSA
Middle Name:EILEEN
Last Name:FERNANDEZ-VIVAR
Suffix:
Gender:F
Credentials:MS,CCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2044 PUEBLO NUEVO CIR
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79936-3712
Mailing Address - Country:US
Mailing Address - Phone:915-255-5587
Mailing Address - Fax:
Practice Address - Street 1:2044 PUEBLO NUEVO CIR
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79936-3712
Practice Address - Country:US
Practice Address - Phone:915-255-5587
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-05
Last Update Date:2022-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX110789235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist