Provider Demographics
NPI:1275727729
Name:GARCIA, LOUISA CARRILLO (MS,CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:LOUISA
Middle Name:CARRILLO
Last Name:GARCIA
Suffix:
Gender:F
Credentials:MS,CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2424 SANTA CRUZ LN
Mailing Address - Street 2:
Mailing Address - City:ODESSA
Mailing Address - State:TX
Mailing Address - Zip Code:79763-2285
Mailing Address - Country:US
Mailing Address - Phone:432-335-0535
Mailing Address - Fax:432-582-2303
Practice Address - Street 1:808 TOWER DR.
Practice Address - Street 2:STE 7
Practice Address - City:ODESSA
Practice Address - State:TX
Practice Address - Zip Code:79761
Practice Address - Country:US
Practice Address - Phone:432-335-8777
Practice Address - Fax:432-335-8787
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-28
Last Update Date:2007-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX100936235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist