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General NPI Number Information
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NPI Number | 1548743925
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Entity Type | Individual
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Provider Name | TALLULAH RACHEL BRESLIN SLP
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Gender |
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Dates
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Enumeration Date | 09/11/2018
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Last Update Date | 06/03/2024
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Provider Practice Location Address
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Address Line | 701 WALSH HILL TRL
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City | CEDAR PARK
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State | TX
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Zip | 78613-4855
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Country | US
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Telephone | 512-649-3119
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Fax | 855-933-2649
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Provider Business Mailing Address
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Address Line | 701 WALSH HILL TRL
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City | CEDAR PARK
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State | TX
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Zip | 78613-4855
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Country | US
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Telephone | 512-649-3119
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Fax | 855-933-2649
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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 | 7101007562
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License Number State | MI
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Taxonomy #2
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number | 111967
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License Number State | TX
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