Provider Demographics
NPI:1225681299
Name:ARCHER, ADELAIDE PENELOPE (MS, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:ADELAIDE
Middle Name:PENELOPE
Last Name:ARCHER
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 1:3400 HARMON AVE APT 306
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78705-2361
Mailing Address - Country:US
Mailing Address - Phone:210-859-4149
Mailing Address - Fax:
Practice Address - Street 1:1711 FRATE BARKER RD
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78748-3600
Practice Address - Country:US
Practice Address - Phone:210-859-4149
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-18
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX114659235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist