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General NPI Number Information
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NPI Number | 1871392381
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Entity Type | Organization
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Legal Business Name | STRIDEWELL LLC
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Dates
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Enumeration Date | 03/10/2025
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Last Update Date | 06/23/2025
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Provider Practice Location Address
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Address Line | 2021 GUADALUPE ST STE 260
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City | AUSTIN
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State | TX
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Zip | 78705-5654
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Country | US
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Telephone | 225-443-3645
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Fax |
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Provider Business Mailing Address
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Address Line | 12856 N HWY 183 STE B #2102
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City | AUSTIN
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State | TX
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Zip | 78750-3222
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Country | US
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Telephone | 225-443-3645
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Fax | 833-685-0729
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Authorized Official
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Title or Position | OWNER
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Name | STEVE CIANCIO
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Credential |
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Telephone | 225-443-3645
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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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Taxonomy #2
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Taxonomy Code | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number |
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License Number State |
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