MEDICARE: MRS. ALICE SANTILLANES 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
1	235Z00000X	Speech-Language Pathologist	18212	TX

General Provider Information

NPI Number	:	1861716557
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. ALICE SANTILLANES CCC-SLP

Provider Business Mailing Address
First Line	:	4613 RINGGOLD LN
Second Line	:
City	:	PLANO
State	:	TX
Zip	:	75093-3947
Country	:	US
Telephone Number	:	972-822-3333
Fax Number	:

Provider Business Practice Location Address
First Line	:	4613 RINGGOLD LN
Second Line	:
City	:	PLANO
State	:	TX
Zip	:	75093-3947
Country	:	US
Telephone Number	:	972-822-3333
Fax Number	:

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

Provider Enumeration Date	:	03/24/2010
Last Update Date	:	03/24/2010

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Directions to “ MRS. ALICE SANTILLANES CCC-SLP” Practice Location

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