Provider Demographics
NPI:1962270132
Name:ITURRALDE, SOFIA (MS, CCC-SLP)
Entity type:Individual
Prefix:
First Name:SOFIA
Middle Name:
Last Name:ITURRALDE
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 1:6318 KRONE LN
Mailing Address - Street 2:
Mailing Address - City:LAREDO
Mailing Address - State:TX
Mailing Address - Zip Code:78041-6217
Mailing Address - Country:US
Mailing Address - Phone:956-693-7089
Mailing Address - Fax:
Practice Address - Street 1:6318 KRONE LN
Practice Address - Street 2:
Practice Address - City:LAREDO
Practice Address - State:TX
Practice Address - Zip Code:78041-6217
Practice Address - Country:US
Practice Address - Phone:956-693-7089
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-12-18
Last Update Date:2023-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX114301235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist