Provider Demographics
NPI:1023106564
Name:DULA, LETICIA LAURA (MA CCC / SLP)
Entity type:Individual
Prefix:MS
First Name:LETICIA
Middle Name:LAURA
Last Name:DULA
Suffix:
Gender:F
Credentials:MA CCC / SLP
Other - Prefix:
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Mailing Address - Street 1:501 N SPUR 63
Mailing Address - Street 2:SUITE # B3
Mailing Address - City:LONGVIEW
Mailing Address - State:TX
Mailing Address - Zip Code:75601-5013
Mailing Address - Country:US
Mailing Address - Phone:903-663-9946
Mailing Address - Fax:903-663-5580
Practice Address - Street 1:501 N SPUR 63
Practice Address - Street 2:SUITE # B3
Practice Address - City:LONGVIEW
Practice Address - State:TX
Practice Address - Zip Code:75601-5013
Practice Address - Country:US
Practice Address - Phone:903-663-9946
Practice Address - Fax:903-663-5580
Is Sole Proprietor?:No
Enumeration Date:2006-10-10
Last Update Date:2010-09-10
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TX101127235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1610255-01Medicaid