Healthcare Provider Details

I. General information

NPI: 1124432448
Provider Name (Legal Business Name): JOHANNA A ESCOBAR MS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/13/2014
Last Update Date: 06/15/2023
Certification Date: 06/15/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9900 WESTPARK DR
HOUSTON TX
77063
US

IV. Provider business mailing address

10120 WINDING CREEK LN
BROOKSHIRE TX
77423-1920
US

V. Phone/Fax

Practice location:
  • Phone: 171-352-8303
  • Fax:
Mailing address:
  • Phone: 832-933-5668
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2355S0801X
TaxonomySpeech-Language Assistant
License Number2350
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number114861
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: