MEDICARE: MRS. EVALIS RAQUEL CHAPA CCC/SLP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	235Z00000X	Speech-Language Pathologist	16602	TX

General Provider Information

NPI Number	:	1841939006
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. EVALIS RAQUEL CHAPA CCC/SLP

Provider Business Mailing Address
First Line	:	3344 HAMILTON AVE
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76107-1851
Country	:	US
Telephone Number	:	817-602-8011
Fax Number	:

Provider Business Practice Location Address
First Line	:	7325 KERMIT AVE
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76116-9434
Country	:	US
Telephone Number	:	817-815-6600
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/03/2022
Last Update Date	:	06/03/2022

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Directions to “ MRS. EVALIS RAQUEL CHAPA CCC/SLP” Practice Location

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