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General NPI Number Information
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NPI Number | 1962715706
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Entity Type | Organization
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Legal Business Name | MI CASA SPEECH AND LANGUAGE THERAPY
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Dates
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Enumeration Date | 07/21/2010
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Last Update Date | 07/21/2010
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Provider Practice Location Address
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Address Line | 2509 TOULOUSE DR
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City | AUSTIN
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State | TX
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Zip | 78748-6049
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Country | US
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Telephone | 512-909-1684
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Fax |
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Provider Business Mailing Address
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Address Line | 2509 TOULOUSE DR
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City | AUSTIN
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State | TX
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Zip | 78748-6049
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Country | US
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Telephone | 512-909-1684
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. MARY ANNE NERICCIO
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Credential | PHD
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Telephone | 512-909-1684
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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 | 10310
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License Number State | TX
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