MEDICARE: MIREYA CAMPA SLP-A

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
1	2355S0801X	Speech-Language Assistant	35230	TX

General Provider Information

NPI Number	:	1063786267
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MIREYA CAMPA SLP-A

Provider Business Mailing Address
First Line	:	340 N SAM HOUSTON PKWY E STE 199
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77060-3325
Country	:	US
Telephone Number	:	281-822-0808
Fax Number	:

Provider Business Practice Location Address
First Line	:	340 N SAM HOUSTON PKWY E STE 199
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77060-3325
Country	:	US
Telephone Number	:	281-822-0808
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/06/2012
Last Update Date	:	03/06/2012

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Directions to “ MIREYA CAMPA SLP-A” Practice Location

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