Provider Demographics
NPI:1346773967
Name:TELLEZ, SARA MORGAN (SPA)
Entity Type:Individual
Prefix:MRS
First Name:SARA
Middle Name:MORGAN
Last Name:TELLEZ
Suffix:
Gender:F
Credentials:SPA
Other - Prefix:
Other - First Name:SARA
Other - Middle Name:MORGAN
Other - Last Name:DAVIS-MURRAY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2500 W WILLIAM CANNON DR # 704
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78745-5257
Mailing Address - Country:US
Mailing Address - Phone:512-887-2126
Mailing Address - Fax:
Practice Address - Street 1:2500 W WILLIAM CANNON DR STE 704
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78745-5257
Practice Address - Country:US
Practice Address - Phone:512-887-2126
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-04-10
Last Update Date:2021-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX410722355S0801X
CA42972355S0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
14357642OtherAMERICAN SPEECH AND HEARING ASSOCIATION
TX41072OtherTEXAS DEPARTMENT OF LICENCING AND REGULATION
CASPA4297OtherSLPAHADB