Doctor Name: | CLETA (BETH) DERKOWSKI |
NPI Number: | 1316251812 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | SLP |
License Number: | 17167 |
Business Practice Address: | 5306 Trail Lake Dr Fort Worth, TX - 761331931 |
Business Phone Number: | 8174330721 |
Business Fax Number: | |
Mailing Address: | 118 Maxey Rd, LONGVIEW |
State: | TX |
Postal Code: | 756058243 |
Phone Number: | 8174330721 |
Fax Number: | |
NPI Enumeration Date: | 07/27/2010 |
NPI Last Update Date: | 07/27/2010 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 235Z00000X |
License Number: | 17167 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | TX |
Taxonomy Type: | Speech, Language and Hearing Service Providers |
Taxonomy Classification: | Speech-Language Pathologist |
Taxonomy Specialization: | |
Taxonomy Definition: | A speech pathologist is a person qualified by a master |