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General NPI Number Information
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NPI Number | 1255990727
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Entity Type | Organization
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Legal Business Name | AUSTIN SPEECH PATHOLOGY, PLLC
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Dates
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Enumeration Date | 06/10/2019
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Last Update Date | 05/11/2020
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Provider Practice Location Address
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Address Line | 711 W 38TH ST BLDG F2
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City | AUSTIN
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State | TX
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Zip | 78705-1121
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Country | US
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Telephone | 512-550-6857
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Fax |
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Provider Business Mailing Address
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Address Line | 711 W 38TH ST BLDG F2
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City | AUSTIN
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State | TX
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Zip | 78705-1121
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Country | US
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Telephone | 512-550-6857
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Fax |
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Authorized Official
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Title or Position | OWNER/LEAD THERAPIST
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Name | MRS. KELLI JENKINES BROUSSARD
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Credential | MS, CCC-SLP
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Telephone | 512-550-6857
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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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