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General NPI Number Information
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NPI Number | 1144785924
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Entity Type | Organization
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Legal Business Name | BOCALINGUAL SPEECH THERAPY LLC
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Dates
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Enumeration Date | 02/05/2019
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Last Update Date | 02/05/2019
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Provider Practice Location Address
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Address Line | 902 KITTY HAWK RD STE 170-450
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City | UNIVERSAL CITY
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State | TX
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Zip | 78148-3825
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Country | US
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Telephone | 210-608-9220
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Fax | 210-695-7028
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Provider Business Mailing Address
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Address Line | 902 KITTY HAWK RD STE 170-450
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City | UNIVERSAL CITY
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State | TX
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Zip | 78148-3825
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Country | US
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Telephone | 210-608-9220
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Fax | 210-695-7028
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Authorized Official
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Title or Position | OWNER
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Name | BLANCA E ANDON
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Credential | SLP
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Telephone | 210-608-9220
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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 |
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License Number State |
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