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General NPI Number Information
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NPI Number | 1558611798
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Entity Type | Organization
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Legal Business Name | STAR SPEECH THERAPY
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Dates
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Enumeration Date | 09/14/2012
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Last Update Date | 09/14/2012
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Provider Practice Location Address
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Address Line | 1319 3RD ST
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City | FLORESVILLE
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State | TX
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Zip | 78114-1961
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Country | US
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Telephone | 830-393-7200
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Fax | 830-393-7206
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Provider Business Mailing Address
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Address Line | PO BOX 1207
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City | POTH
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State | TX
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Zip | 78147-1207
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Country | US
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Telephone | 830-393-7200
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Fax | 830-393-7206
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Authorized Official
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Title or Position | PARTNER
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Name | MRS. CHRISTINA CERVANTES
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Credential | LBSW
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Telephone | 830-393-7200
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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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