Provider Demographics
NPI:1083362321
Name:CHRYSALIS APHASIA AND ADULT SPEECH REHABILITATION
Entity Type:Organization
Organization Name:CHRYSALIS APHASIA AND ADULT SPEECH REHABILITATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SPEECH- LANGUAGE PATHOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:JACQUELINE
Authorized Official - Middle Name:NICOLE
Authorized Official - Last Name:ALVARADO
Authorized Official - Suffix:
Authorized Official - Credentials:MS, CCC-SLP
Authorized Official - Phone:915-820-3944
Mailing Address - Street 1:3905 JEFFERSON AVE
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79930-6613
Mailing Address - Country:US
Mailing Address - Phone:915-820-3944
Mailing Address - Fax:
Practice Address - Street 1:3905 JEFFERSON AVE
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79930-6613
Practice Address - Country:US
Practice Address - Phone:915-820-3944
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-03-15
Last Update Date:2022-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty