Provider Demographics
NPI:1346759479
Name:SHORTILL, BLANCA ISELA (SLP)
Entity Type:Individual
Prefix:
First Name:BLANCA
Middle Name:ISELA
Last Name:SHORTILL
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 1:5709 N BROADWAY ST
Mailing Address - Street 2:
Mailing Address - City:MCALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:78504-4415
Mailing Address - Country:US
Mailing Address - Phone:956-580-9911
Mailing Address - Fax:956-580-8257
Practice Address - Street 1:2105 W MILE 3 RD STE 7
Practice Address - Street 2:
Practice Address - City:MISSION
Practice Address - State:TX
Practice Address - Zip Code:78573-6732
Practice Address - Country:US
Practice Address - Phone:956-766-7083
Practice Address - Fax:956-766-7084
Is Sole Proprietor?:Yes
Enumeration Date:2017-09-20
Last Update Date:2024-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX109355235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist