Individual
CLETA (BETH) DERKOWSKI
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
SLP
Contact information
Practice address
1701 PINE TREE RD, LONGVIEW, TX 75604-1909
(903) 295-5170
Mailing address
118 MAXEY RD, LONGVIEW, TX 75605-8243
(903) 445-2193
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
17167
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
149984001
—
TX
Enumeration date
07/27/2010
Last updated
07/31/2023
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