Healthcare Provider Details

I. General information

NPI: 1518445485
Provider Name (Legal Business Name): MISS MONICA ESCOTT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/02/2018
Last Update Date: 08/02/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

410 W 2ND ST
RIO GRANDE CITY TX
78582-3608
US

IV. Provider business mailing address

410 W 2ND ST
RIO GRANDE CITY TX
78582-3608
US

V. Phone/Fax

Practice location:
  • Phone: 956-735-5058
  • Fax:
Mailing address:
  • Phone: 956-735-5058
  • Fax: 956-486-2675

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2355S0801X
TaxonomySpeech-Language Assistant
License Number39826
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: