Provider Demographics
NPI:1043455629
Name:SOTO, AUDRA GAIL (MS,CCC/SLP)
Entity Type:Individual
Prefix:MRS
First Name:AUDRA
Middle Name:GAIL
Last Name:SOTO
Suffix:
Gender:F
Credentials:MS,CCC/SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6002 NACAHUITA LN
Mailing Address - Street 2:
Mailing Address - City:HARLINGEN
Mailing Address - State:TX
Mailing Address - Zip Code:78552-1908
Mailing Address - Country:US
Mailing Address - Phone:956-647-8762
Mailing Address - Fax:
Practice Address - Street 1:3804 S JACKSON RD # 1
Practice Address - Street 2:
Practice Address - City:EDINBURG
Practice Address - State:TX
Practice Address - Zip Code:78539-6681
Practice Address - Country:US
Practice Address - Phone:956-296-3001
Practice Address - Fax:956-296-3000
Is Sole Proprietor?:No
Enumeration Date:2008-12-10
Last Update Date:2020-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX102914235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXH08LZ45701OtherBCBS
TX387283003Medicaid
TX387283002Medicaid