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General NPI Number Information
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NPI Number | 1376043075
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Entity Type | Individual
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Provider Name | NATALIE MARIE DEERHAKE M.A. CCC-SLP
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Gender | Female
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Dates
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Enumeration Date | 02/19/2018
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Last Update Date | 02/19/2018
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Provider Practice Location Address
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Address Line | 2000 W BAKER RD
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City | BAYTOWN
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State | TX
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Zip | 77521-2259
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Country | US
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Telephone | 281-427-9120
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Fax |
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Provider Business Mailing Address
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Address Line | 12 OAK PL UNIT 20
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City | HOUSTON
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State | TX
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Zip | 77006-1798
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Country | US
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Telephone | 440-539-1707
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number | 110881
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License Number State | TX
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