Provider Demographics
NPI:1093088742
Name:HEART TO HEAR PEDIATRIC THERAPY, PLLC
Entity Type:Organization
Organization Name:HEART TO HEAR PEDIATRIC THERAPY, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:VICTORIA
Authorized Official - Middle Name:ELENA PENA
Authorized Official - Last Name:SPOON
Authorized Official - Suffix:
Authorized Official - Credentials:MS,CCC-SLP, CERTAVT
Authorized Official - Phone:915-566-8097
Mailing Address - Street 1:3320 DUBLIN RD
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79925-2833
Mailing Address - Country:US
Mailing Address - Phone:915-566-8097
Mailing Address - Fax:915-629-9753
Practice Address - Street 1:3320 DUBLIN RD
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79925-2833
Practice Address - Country:US
Practice Address - Phone:915-566-8097
Practice Address - Fax:915-629-9753
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-10
Last Update Date:2012-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX101620235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX219837601Medicaid