Healthcare Provider Details

I. General information

NPI: 1447420161
Provider Name (Legal Business Name): CHRISTIE LYNN AYLSWORTH MS/CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/10/2008
Last Update Date: 01/05/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10515 GULFDALE
SAN ANTONIO TX
78216-3602
US

IV. Provider business mailing address

7106 LYNN LAKE DR
SAN ANTONIO TX
78244-2095
US

V. Phone/Fax

Practice location:
  • Phone: 210-340-2627
  • Fax: 210-340-6437
Mailing address:
  • Phone: 210-722-0141
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number19551
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: