Healthcare Provider Details

I. General information

NPI: 1659113041
Provider Name (Legal Business Name): CHRISTINE C GUAJARDO SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/07/2024
Last Update Date: 07/09/2025
Certification Date: 07/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9514 CONSOLE DR STE 102
SAN ANTONIO TX
78229-2042
US

IV. Provider business mailing address

9514 CONSOLE DR STE 102
SAN ANTONIO TX
78229-2042
US

V. Phone/Fax

Practice location:
  • Phone: 210-448-9111
  • Fax: 210-308-9595
Mailing address:
  • Phone: 210-448-9111
  • Fax: 210-308-9595

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number122346
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: