Vanessa Iliana Vargas
Individual provider Active NPI Speech-Language Pathologist · Jacksonvilel, FL
NPI 1306135751 · NPPES record last updated Jan 30, 2025
Key facts
- NPI
- 1306135751
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Speech-Language Pathologist 235Z00000X
- License
- 115150 (TX)
- Practice address
- 12276 San Jose Blve
Suite 508
Jacksonvilel, FL 32222-8618 - Phone
- (904) 886-3228
- Fax
- (904) 404-7743
- NPI assigned
- Apr 6, 2011
- Sex
- Female
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 115150 | TX | MD | Social Worker |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Speech-Language Pathologist | 235Z00000X | 115150 | TX | Yes |
Addresses
Primary practice location
12276 San Jose Blve
Suite 508
Jacksonvilel, FL 32222-8618
Mailing address
19075 Somerset Rd Unit 1
Lytle, TX 78052-4111
Phone (210) 518-8103
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jan 30, 2025. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.