Healthcare Provider Details

I. General information

NPI: 1093175622
Provider Name (Legal Business Name): ABIGAIL PALACIOS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/24/2016
Last Update Date: 02/24/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

702 GALVESTON ST
LAREDO TX
78040-4638
US

IV. Provider business mailing address

702 GALVESTON ST
LAREDO TX
78040-4638
US

V. Phone/Fax

Practice location:
  • Phone: 956-568-4571
  • Fax: 956-568-4671
Mailing address:
  • Phone: 956-568-4571
  • Fax: 956-568-4671

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2355S0801X
TaxonomySpeech-Language Assistant
License Number39496
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: