Healthcare Provider Details

I. General information

NPI: 1629551270
Provider Name (Legal Business Name): PATRICIA MAYS WHITE M.S. CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: PATRICIA PORTER MAYS M.S. CCC-SLP

II. Dates (important events)

Enumeration Date: 09/10/2018
Last Update Date: 09/10/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1500 COTTONWOOD CREEK TRL
CEDAR PARK TX
78613-7555
US

IV. Provider business mailing address

1500 COTTONWOOD CREEK TRL
CEDAR PARK TX
78613-7555
US

V. Phone/Fax

Practice location:
  • Phone: 512-259-4259
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number113391
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: