Provider Demographics
NPI:1255989968
Name:ALCALA, VANESSA (MS CCC-SLP)
Entity type:Individual
Prefix:
First Name:VANESSA
Middle Name:
Last Name:ALCALA
Suffix:
Gender:F
Credentials:MS 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:PO BOX 388
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33601-0388
Mailing Address - Country:US
Mailing Address - Phone:813-250-9101
Mailing Address - Fax:813-844-4952
Practice Address - Street 1:4125 GUNN HWY STE B
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33618-8788
Practice Address - Country:US
Practice Address - Phone:813-454-3711
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-27
Last Update Date:2023-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
235Z00000X
FLSA18563235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist