Healthcare Provider Details

I. General information

NPI: 1598070468
Provider Name (Legal Business Name): ASHLEY KRISTINE ESCAMILLA SLPA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/16/2010
Last Update Date: 08/16/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4206 RETAMA CIR
VICTORIA TX
77901-2765
US

IV. Provider business mailing address

6803 N NAVARRO ST APT 48
VICTORIA TX
77904-1530
US

V. Phone/Fax

Practice location:
  • Phone: 361-582-0611
  • Fax: 361-582-4805
Mailing address:
  • Phone: 361-582-0611
  • Fax: 361-582-4805

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2355S0801X
TaxonomySpeech-Language Assistant
License Number35552
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: