Provider Demographics
NPI:1003238833
Name:WAKE, AISLINN M (MS CCC/SLP)
Entity Type:Individual
Prefix:MRS
First Name:AISLINN
Middle Name:M
Last Name:WAKE
Suffix:
Gender:F
Credentials:MS CCC/SLP
Other - Prefix:MS
Other - First Name:AISLINN
Other - Middle Name:M
Other - Last Name:WHYTE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, CCC-SLP
Mailing Address - Street 1:3745 LAZY DIAMOND
Mailing Address - Street 2:
Mailing Address - City:SELMA
Mailing Address - State:TX
Mailing Address - Zip Code:78154-3530
Mailing Address - Country:US
Mailing Address - Phone:210-683-0836
Mailing Address - Fax:
Practice Address - Street 1:10609 IH 10 W STE 201
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78230-1673
Practice Address - Country:US
Practice Address - Phone:210-344-5437
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-01-14
Last Update Date:2019-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX108592235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist