MEDICARE: OLIVIA ROSE WALZ CCC-SLP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	235Z00000X	Speech-Language Pathologist	122282	TX

General Provider Information

NPI Number	:	1316838089
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	OLIVIA ROSE WALZ CCC-SLP

Provider Business Mailing Address
First Line	:	1828 WALDRON RD
Second Line	:
City	:	CORPUS CHRISTI
State	:	TX
Zip	:	78418-4538
Country	:	US
Telephone Number	:	361-792-0822
Fax Number	:	361-288-4109

Provider Business Practice Location Address
First Line	:	1828 WALDRON RD
Second Line	:
City	:	CORPUS CHRISTI
State	:	TX
Zip	:	78418-4538
Country	:	US
Telephone Number	:	361-792-0822
Fax Number	:	361-288-4109

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/11/2025
Last Update Date	:	07/11/2025

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