Provider Demographics
NPI:1477726297
Name:ORNELAS, MYRNA J (MS CCC/SLP)
Entity Type:Individual
Prefix:
First Name:MYRNA
Middle Name:J
Last Name:ORNELAS
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 1:1815 VILLA LINDA AVE APT 1
Mailing Address - Street 2:
Mailing Address - City:EDINBURG
Mailing Address - State:TX
Mailing Address - Zip Code:78541-9857
Mailing Address - Country:US
Mailing Address - Phone:965-316-2058
Mailing Address - Fax:
Practice Address - Street 1:1815 VILLA LINDA AVE APT 1
Practice Address - Street 2:
Practice Address - City:EDINBURG
Practice Address - State:TX
Practice Address - Zip Code:78541-9857
Practice Address - Country:US
Practice Address - Phone:965-316-2058
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-13
Last Update Date:2008-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX14464235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist