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General NPI Number Information
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NPI Number | 1043598139
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Entity Type | Organization
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Legal Business Name | SPEECH AUTHORITY OF AUSTIN
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Dates
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Enumeration Date | 07/24/2011
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Last Update Date | 07/24/2011
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Provider Practice Location Address
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Address Line | 12609 RUSH CREEK LN
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City | AUSTIN
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State | TX
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Zip | 78732-1992
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Country | US
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Telephone | 512-297-5499
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Fax |
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Provider Business Mailing Address
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Address Line | 12609 RUSH CREEK LN
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City | AUSTIN
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State | TX
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Zip | 78732-1992
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | MEMBER
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Name | LAVONNE LORG
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Credential |
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Telephone | 512-297-5499
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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 | 101087
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License Number State | TX
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