MEDICARE: LAURA JEAN SALAS MA, 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	110440	TX

General Provider Information

NPI Number	:	1962876862
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LAURA JEAN SALAS MA, CCC/SLP

Provider Business Mailing Address
First Line	:	12708 RIATA VISTA CIR STE A-106
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78727-7174
Country	:	US
Telephone Number	:	713-204-7602
Fax Number	:

Provider Business Practice Location Address
First Line	:	12708 RIATA VISTA CIR STE A-106
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78727-7174
Country	:	US
Telephone Number	:	713-204-7602
Fax Number	:

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

Provider Enumeration Date	:	11/16/2015
Last Update Date	:	03/17/2018

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