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General NPI Number Information
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NPI Number | 1003238833
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Entity Type | Individual
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Provider Name | AISLINN M WAKE MS CCC/SLP
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Gender | Female
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Dates
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Enumeration Date | 01/14/2014
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Last Update Date | 11/08/2019
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Provider Practice Location Address
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Address Line | 10609 IH 10 W STE 201
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City | SAN ANTONIO
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State | TX
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Zip | 78230-1673
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Country | US
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Telephone | 210-344-5437
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Fax |
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Provider Business Mailing Address
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Address Line | 3745 LAZY DIAMOND
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City | SELMA
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State | TX
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Zip | 78154-3530
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Country | US
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Telephone | 210-683-0836
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number | 108592
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License Number State | TX
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