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General NPI Number Information
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NPI Number | 1871004903
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Entity Type | Organization
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Legal Business Name | GREATER AUSTIN SPEECH AND LANGUAGE THERAPY, PLLC
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Dates
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Enumeration Date | 10/16/2017
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Last Update Date | 10/16/2017
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Provider Practice Location Address
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Address Line | 16800 ENNIS TRL
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City | AUSTIN
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State | TX
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Zip | 78717-5506
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Country | US
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Telephone | 737-888-1024
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Fax | 512-233-0693
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Provider Business Mailing Address
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Address Line | 6000 SHEPHERD MOUNTAIN CV UNIT 1004
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City | AUSTIN
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State | TX
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Zip | 78730-4904
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Country | US
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Telephone | 737-888-1024
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Fax | 512-233-0693
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Authorized Official
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Title or Position | OWNER
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Name | KAITING BRONSON
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Credential | MS, CCC/SLP
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Telephone | 737-888-1024
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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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