MEDICARE: AUSTIN SPEECH THERAPY PLLC

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	:	1861115438
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AUSTIN SPEECH THERAPY PLLC

Provider Business Mailing Address
First Line	:	4807 SPICEWOOD SPRINGS RD STE 1120
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78759-8435
Country	:	US
Telephone Number	:	737-326-0393
Fax Number	:	512-617-7443

Provider Business Practice Location Address
First Line	:	4202 SPICEWOOD SPRINGS RD STE 116
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78759-8621
Country	:	US
Telephone Number	:	737-826-0393
Fax Number	:	512-617-7443

Authorized Official
Title or Position	:	OWNER
Name	:	ANGELA SOTOLONGO-GREWAL
Credential	:	SLP
Telephone Number	:	737-826-0393

Provider Enumeration Date	:	09/20/2022
Last Update Date	:	09/18/2024

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Directions to “AUSTIN SPEECH THERAPY PLLC ” Practice Location

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