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NPI Code Detail

MEDICARE: OUR LADY OF THE LAKE UNIVERSITY

MEDICARE: OUR LADY OF THE LAKE UNIVERSITY
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1235Z00000XSpeech-Language Pathologist11218TX

General Provider Information

NPI Number : 1063622314
Entity Type Code : Organization
Provider Name (Legal Business Name) : OUR LADY OF THE LAKE UNIVERSITY
Provider Business Mailing Address
First Line : 411 SW 24TH ST
Second Line :
City : SAN ANTONIO
State : TX
Zip : 78207-4617
Country : US
Telephone Number : 210-434-6711
Fax Number : 210-434-9360
Provider Business Practice Location Address
First Line : 411 SW 24TH ST
Second Line :
City : SAN ANTONIO
State : TX
Zip : 78207-4617
Country : US
Telephone Number : 210-434-6711
Fax Number : 210-434-9360
Authorized Official
Title or Position : DIRECTOR
Name : DR. MARY ANN ACEVEDO
Credential : PH. D.
Telephone Number : 210-434-6711
Provider Enumeration Date : 05/23/2007
Last Update Date : 08/22/2020

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Directions to “OUR LADY OF THE LAKE UNIVERSITY ” Practice Location

Language Start Address Practice Location
These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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