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NPI Code Detail

MEDICARE: MRS. YLSSE KRISTEL MALDONADO M.S., CCC-SLP

MEDICARE:  MRS. YLSSE KRISTEL MALDONADO  M.S., CCC-SLP
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 Pathologist109613TX

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1109613OTHERTXTEXAS DEPARTMENT OF LICENSING AND REGULATION

General Provider Information

NPI Number : 1629559356
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. YLSSE KRISTEL MALDONADO M.S., CCC-SLP
Provider Business Mailing Address
First Line : 5415 DUKE FLD
Second Line :
City : SAN ANTONIO
State : TX
Zip : 78227-4723
Country : US
Telephone Number : 956-285-2590
Fax Number :
Provider Business Practice Location Address
First Line : 5100 JOHN D RYAN BLVD
Second Line :
City : SAN ANTONIO
State : TX
Zip : 78245-3527
Country : US
Telephone Number : 210-568-3415
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/21/2018
Last Update Date : 08/21/2018

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Directions to “ MRS. YLSSE KRISTEL MALDONADO M.S., CCC-SLP” Practice Location

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