Healthcare Provider Details

I. General information

NPI: 1023360468
Provider Name (Legal Business Name): CORTNEY NICOLE LHOTA SLP-CCC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/10/2012
Last Update Date: 07/05/2023
Certification Date: 07/05/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6448 E HIGHWAY 290 STE E106
AUSTIN TX
78723-1041
US

IV. Provider business mailing address

3709 GROOMS ST
AUSTIN TX
78705-1626
US

V. Phone/Fax

Practice location:
  • Phone: 512-808-3953
  • Fax:
Mailing address:
  • Phone: 305-905-7204
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number114304
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberSZ 5850
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: