Provider Demographics
NPI:1033152897
Name:KAPAUN, WANDA A (MSCCCSLP)
Entity Type:Individual
Prefix:MRS
First Name:WANDA
Middle Name:A
Last Name:KAPAUN
Suffix:
Gender:F
Credentials:MSCCCSLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16142 PIONCIANA ST
Mailing Address - Street 2:
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78418-6508
Mailing Address - Country:US
Mailing Address - Phone:361-563-8460
Mailing Address - Fax:361-949-3014
Practice Address - Street 1:16142 PIONCIANA ST
Practice Address - Street 2:
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78418-6508
Practice Address - Country:US
Practice Address - Phone:361-563-8460
Practice Address - Fax:361-949-3014
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-13
Last Update Date:2018-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX102425235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX164704201Medicaid