Healthcare Provider Details

I. General information

NPI: 1215707542
Provider Name (Legal Business Name): ANAYELY ESCOBAR
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/08/2024
Last Update Date: 01/08/2024
Certification Date: 01/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16301 ELEMENTARY DR
JUSTIN TX
76247-5785
US

IV. Provider business mailing address

1013 BETTY ST
DUBLIN TX
76446-2141
US

V. Phone/Fax

Practice location:
  • Phone: 254-979-7026
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2355S0801X
TaxonomySpeech-Language Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: