Healthcare Provider Details

I. General information

NPI: 1760006159
Provider Name (Legal Business Name): LISA COWLING TSCHIRHART MA, CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/02/2020
Last Update Date: 06/02/2020
Certification Date: 06/02/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9901 W IH 10 STE 615
SAN ANTONIO TX
78230-2246
US

IV. Provider business mailing address

1906 RIALTO WAY
SAN ANTONIO TX
78230-0932
US

V. Phone/Fax

Practice location:
  • Phone: 210-691-0039
  • Fax:
Mailing address:
  • Phone: 210-259-5858
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number107786
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: