MEDICARE: LOURDES GEORGINA SALINAS MS SLP-CCC

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	112346	TX

General Provider Information

NPI Number	:	1437788643
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LOURDES GEORGINA SALINAS MS SLP-CCC

Provider Business Mailing Address
First Line	:	250 BENS TRL
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76120-7000
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2473 N FIELD ST APT 3014
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75201-8208
Country	:	US
Telephone Number	:	469-350-4874
Fax Number	:

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

Provider Enumeration Date	:	04/08/2020
Last Update Date	:	04/08/2020

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Directions to “ LOURDES GEORGINA SALINAS MS SLP-CCC” Practice Location

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