Healthcare Provider Details

I. General information

NPI: 1063729473
Provider Name (Legal Business Name): CORRIE CAVADA SLP MS-CCC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/07/2010
Last Update Date: 09/07/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7390 BARLITE BLVD SUITE 315
SAN ANTONIO TX
78224-1337
US

IV. Provider business mailing address

7390 BARLITE BLVD SUITE 315
SAN ANTONIO TX
78224-1337
US

V. Phone/Fax

Practice location:
  • Phone: 210-787-1583
  • Fax: 210-921-0009
Mailing address:
  • Phone: 210-787-1583
  • Fax: 210-921-0009

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number103193
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: