Provider Demographics
NPI:1447677190
Name:PEREZ, MAYRA DORALI (MS, CCC-SLO)
Entity type:Individual
Prefix:MRS
First Name:MAYRA
Middle Name:DORALI
Last Name:PEREZ
Suffix:
Gender:F
Credentials:MS, CCC-SLO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20121 CHAYTON CIR
Mailing Address - Street 2:
Mailing Address - City:PFLUGERVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78660-7795
Mailing Address - Country:US
Mailing Address - Phone:512-809-9604
Mailing Address - Fax:
Practice Address - Street 1:3409 EXCECUTIVE CENTER DR
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78731
Practice Address - Country:US
Practice Address - Phone:512-359-3703
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-03-19
Last Update Date:2014-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX102474235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist