=====================================================
General NPI Number Information
=====================================================
NPI Number | 1396948725
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SPEECH CENTER OF TEXAS, P.C.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/05/2007
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 15901 CENTRAL COMMERCE DR STE 301
-----------------------------------------------------
City | PFLUGERVILLE
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78660-2041
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 512-251-7775
-----------------------------------------------------
Fax | 512-251-7776
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 15901 CENTRAL COMMERCE DR STE 301
-----------------------------------------------------
City | PFLUGERVILLE
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78660-2041
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 512-251-7775
-----------------------------------------------------
Fax | 512-251-7776
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | SPEECH LANGUAGE PATHOLOGIST
-----------------------------------------------------
Name | CECILIA CRUZ MACKAY
-----------------------------------------------------
Credential | M.A., CCC-SLP
-----------------------------------------------------
Telephone | 512-251-7775
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 235Z00000X
-----------------------------------------------------
Taxonomy Name | Speech-Language Pathologist
-----------------------------------------------------
License Number | 19892
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------