Healthcare Provider Details

I. General information

NPI: 1194131185
Provider Name (Legal Business Name): AMY ESQUIVEL CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/10/2014
Last Update Date: 07/10/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6601 MONTANA AVE STE G&H
EL PASO TX
79925-2155
US

IV. Provider business mailing address

6601 MONTANA AVE STE G&H
EL PASO TX
79925-2155
US

V. Phone/Fax

Practice location:
  • Phone: 915-838-7604
  • Fax: 915-772-4633
Mailing address:
  • Phone: 915-838-7604
  • Fax: 915-772-4633

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number109219
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: