=====================================================
General NPI Number Information
=====================================================
NPI Number | 1952137309
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | EAGLE PASS SPEECH AND LANGUAGE SERVICES
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/11/2024
-----------------------------------------------------
Last Update Date | 09/11/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3189 TINA DR
-----------------------------------------------------
City | EAGLE PASS
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78852-3740
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 830-325-5028
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3189 TINA DR
-----------------------------------------------------
City | EAGLE PASS
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78852-3740
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 830-325-5028
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | SPEECH LANGUAGE PATHOLOGIST
-----------------------------------------------------
Name | MISS CRISTINA CARDENAS
-----------------------------------------------------
Credential | CCC-SLP
-----------------------------------------------------
Telephone | 830-325-5028
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 235Z00000X
-----------------------------------------------------
Taxonomy Name | Speech-Language Pathologist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------