Provider Demographics
NPI:1558611798
Name:STAR SPEECH THERAPY
Entity Type:Organization
Organization Name:STAR SPEECH THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:CHRISTINA
Authorized Official - Middle Name:
Authorized Official - Last Name:CERVANTES
Authorized Official - Suffix:
Authorized Official - Credentials:LBSW
Authorized Official - Phone:830-393-7200
Mailing Address - Street 1:PO BOX 1207
Mailing Address - Street 2:
Mailing Address - City:POTH
Mailing Address - State:TX
Mailing Address - Zip Code:78147-1207
Mailing Address - Country:US
Mailing Address - Phone:830-393-7200
Mailing Address - Fax:830-393-7206
Practice Address - Street 1:1319 3RD ST
Practice Address - Street 2:
Practice Address - City:FLORESVILLE
Practice Address - State:TX
Practice Address - Zip Code:78114-1961
Practice Address - Country:US
Practice Address - Phone:830-393-7200
Practice Address - Fax:830-393-7206
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-09-14
Last Update Date:2012-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty