Healthcare Provider Details

I. General information

NPI: 1629687264
Provider Name (Legal Business Name): ESLP CLINIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/29/2020
Last Update Date: 07/29/2020
Certification Date: 07/29/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

260 DORSET LN
AUSTIN TX
78737-4553
US

IV. Provider business mailing address

260 DORSET LN
AUSTIN TX
78737-4553
US

V. Phone/Fax

Practice location:
  • Phone: 512-710-6861
  • Fax: 512-505-8354
Mailing address:
  • Phone: 512-710-6861
  • Fax: 512-505-8354

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: KERRI L SALVATORE
Title or Position: SPEECH-LANGUAGE PATHOLOGIST /OWNER
Credential: M.S., CCC-SLP
Phone: 512-710-6861