Provider Demographics
NPI:1215603626
Name:GALLARDO, PRISCILLA (SLP)
Entity Type:Individual
Prefix:
First Name:PRISCILLA
Middle Name:
Last Name:GALLARDO
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2504 E GRIFFIN PKWY
Mailing Address - Street 2:
Mailing Address - City:MISSION
Mailing Address - State:TX
Mailing Address - Zip Code:78572-3348
Mailing Address - Country:US
Mailing Address - Phone:956-519-2700
Mailing Address - Fax:956-519-3935
Practice Address - Street 1:2504 E GRIFFIN PKWY
Practice Address - Street 2:
Practice Address - City:MISSION
Practice Address - State:TX
Practice Address - Zip Code:78572-3348
Practice Address - Country:US
Practice Address - Phone:956-519-2700
Practice Address - Fax:956-519-3935
Is Sole Proprietor?:No
Enumeration Date:2021-08-17
Last Update Date:2021-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX118551235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX118551OtherSPEECH AND LANGUAGE PATHOLOGY LICENSE