Provider Demographics
NPI:1275217564
Name:LIZCANO, MEGAN ALYSSA (MS SLP-INTERN)
Entity Type:Individual
Prefix:
First Name:MEGAN
Middle Name:ALYSSA
Last Name:LIZCANO
Suffix:
Gender:F
Credentials:MS SLP-INTERN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6701 RIALTO BLVD APT 5205
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78735-8637
Mailing Address - Country:US
Mailing Address - Phone:956-292-5752
Mailing Address - Fax:
Practice Address - Street 1:12708 RIATA VISTA CIR STE A106
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78727-7174
Practice Address - Country:US
Practice Address - Phone:512-795-2423
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-15
Last Update Date:2023-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX121022235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist