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General NPI Number Information
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NPI Number | 1588136253
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Entity Type | Organization
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Legal Business Name | AUDREY DESPAIN, M.S., CCC-SLP, PLLC
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Dates
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Enumeration Date | 12/19/2018
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Last Update Date | 11/01/2022
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Provider Practice Location Address
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Address Line | 4601 BEGONIA ST
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City | VICTORIA
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State | TX
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Zip | 77904-2133
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Country | US
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Telephone | 361-362-4122
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Fax | 361-288-7200
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Provider Business Mailing Address
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Address Line | 4601 BEGONIA ST
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City | VICTORIA
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State | TX
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Zip | 77904-2133
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Country | US
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Telephone | 361-362-4122
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Fax | 361-288-7200
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Authorized Official
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Title or Position | SPEECH LANGUAGE PATHOLOGIST
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Name | AUDREY DESPAIN
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Credential | MS, CCC-SLP
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Telephone | 361-362-4122
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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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