Active NPI
Therese Roque, MS, CCC-SLP
- Speech-Language Pathologist
- Dallas, TX
National Provider Identifier
1619684198
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Speech-Language Pathologist
- License
- 19698
- Practice address
- 9400 N Central Expy
Dallas, TX 75231-5027 - Phone
- (972) 581-4278
- NPI assigned
- Nov 3, 2022
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Speech-Language Pathologist | 235Z00000X | 19698 | TX | Primary |
Addresses
Primary practice location
9400 N Central Expy
Dallas, TX 75231-5027
Mailing address
4812 Hovenkamp Dr
Dallas, TX 75227-2859
Phone (972) 977-8053
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 120085901 | Medicaid | TX |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Master of Science
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 19698 | TX | MD | Pharmacist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1667433600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1667433600000",
"number": "1619684198",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4812 HOVENKAMP DR",
"city": "DALLAS",
"state": "TX",
"postal_code": "752272859",
"telephone_number": "972-977-8053"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "9400 N CENTRAL EXPY",
"city": "DALLAS",
"state": "TX",
"postal_code": "752315027",
"telephone_number": "972-581-4278"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ROQUE",
"first_name": "THERESE",
"credential": "MS, CCC-SLP",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2022-11-03",
"last_updated": "2022-11-03",
"certification_date": "2022-11-03",
"status": "A"
},
"taxonomies": [
{
"code": "235Z00000X",
"taxonomy_group": "",
"desc": "Speech-Language Pathologist",
"state": "TX",
"license": "19698",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "120085901",
"state": "TX"
}
],
"endpoints": [],
"other_names": []
}Other providers in Dallas, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 3, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.