MEDICARE: BOCALINGUAL SPEECH THERAPY LLC

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	235Z00000X	Speech-Language Pathologist

General Provider Information

NPI Number	:	1144785924
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BOCALINGUAL SPEECH THERAPY LLC

Provider Business Mailing Address
First Line	:	902 KITTY HAWK RD STE 170-450
Second Line	:
City	:	UNIVERSAL CITY
State	:	TX
Zip	:	78148-3825
Country	:	US
Telephone Number	:	210-608-9220
Fax Number	:	210-695-7028

Provider Business Practice Location Address
First Line	:	902 KITTY HAWK RD STE 170-450
Second Line	:
City	:	UNIVERSAL CITY
State	:	TX
Zip	:	78148-3825
Country	:	US
Telephone Number	:	210-608-9220
Fax Number	:	210-695-7028

Authorized Official
Title or Position	:	OWNER
Name	:	BLANCA E ANDON
Credential	:	SLP
Telephone Number	:	210-608-9220

Provider Enumeration Date	:	02/05/2019
Last Update Date	:	02/05/2019

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Directions to “BOCALINGUAL SPEECH THERAPY LLC ” Practice Location

Language	Start Address	Practice Location

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