=====================================================
General NPI Number Information
=====================================================
NPI Number | 1649616202
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MS. ROXANNE ALTUNA
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/22/2013
-----------------------------------------------------
Last Update Date | 06/21/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 223 W ANDERSON LN A-115
-----------------------------------------------------
City | AUSTIN
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78752-1131
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 512-807-8955
-----------------------------------------------------
Fax | 866-561-4982
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1368 ELAINE DR
-----------------------------------------------------
City | ALLEN
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75013-2809
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 512-593-3296
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 235Z00000X
-----------------------------------------------------
Taxonomy Name | Speech-Language Pathologist
-----------------------------------------------------
License Number | 115790
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------