Healthcare Provider Details

I. General information

NPI: 1518347277
Provider Name (Legal Business Name): TEXAS STATE UNIVERSITY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/08/2015
Last Update Date: 08/25/2022
Certification Date: 08/25/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 UNIVERSITY DR SPEECH AND HEARING CLINIC
SAN MARCOS TX
78666-4684
US

IV. Provider business mailing address

601 UNIVERSITY DR
SAN MARCOS TX
78666-4684
US

V. Phone/Fax

Practice location:
  • Phone: 512-245-8241
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number50677
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number80603
License Number StateTX

VIII. Authorized Official

Name: DEBRA JONES
Title or Position: DIR, PAYROLL AND TAX COMPLIANCE
Credential:
Phone: 512-245-2766