Provider Demographics
NPI:1730583774
Name:VAZIRIAN, JENNIFER (CCC SLP)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:VAZIRIAN
Suffix:
Gender:F
Credentials:CCC SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8403 STATE HIGHWAY 151 STE 104
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78245-2055
Mailing Address - Country:US
Mailing Address - Phone:210-779-3592
Mailing Address - Fax:210-520-0464
Practice Address - Street 1:8519 RIDGE STONE ST
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78251-2203
Practice Address - Country:US
Practice Address - Phone:210-779-3592
Practice Address - Fax:210-520-0464
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-20
Last Update Date:2023-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0188501235Z00000X
TX109362235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist