Healthcare Provider Details

I. General information

NPI: 1740610716
Provider Name (Legal Business Name): DAWN ESCAMILLA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/12/2013
Last Update Date: 11/12/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

680 S 4TH ST
LOUISVILLE KY
40202-2407
US

IV. Provider business mailing address

6508 CADDELL ST
AMARILLO TX
79119-6319
US

V. Phone/Fax

Practice location:
  • Phone: 888-884-3093
  • Fax: 888-884-3093
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number01111312
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: