Healthcare Provider Details

I. General information

NPI: 1407328263
Provider Name (Legal Business Name): ERICA ZAVALA M.S. CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/18/2018
Last Update Date: 12/14/2025
Certification Date: 12/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1100 WILFORD HALL LOOP
JBSA LACKLAND TX
78236-5638
US

IV. Provider business mailing address

8913 SHADOW WOOD LN
CONVERSE TX
78109-2020
US

V. Phone/Fax

Practice location:
  • Phone: 210-292-4277
  • Fax:
Mailing address:
  • Phone: 361-816-4007
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number111864
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: