Provider Demographics
NPI:1629158258
Name:CENTRAL TEXAS SPEECH PATHOLOGY SERVICES, INC
Entity Type:Organization
Organization Name:CENTRAL TEXAS SPEECH PATHOLOGY SERVICES, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:LISA
Authorized Official - Middle Name:
Authorized Official - Last Name:FAMIGLIETTI
Authorized Official - Suffix:
Authorized Official - Credentials:MS CCCSLPA
Authorized Official - Phone:512-327-6179
Mailing Address - Street 1:2525 WALLINGWOOD
Mailing Address - Street 2:BLDG #2
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78746
Mailing Address - Country:US
Mailing Address - Phone:512-327-6179
Mailing Address - Fax:512-327-1545
Practice Address - Street 1:2525 WALLINGWOOD
Practice Address - Street 2:BLDG #2
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78746-6900
Practice Address - Country:US
Practice Address - Phone:512-327-6179
Practice Address - Fax:512-327-1545
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-17
Last Update Date:2019-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty
No231H00000XSpeech, Language and Hearing Service ProvidersAudiologistGroup - Multi-Specialty
No261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-SpecialtyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
0A4898Medicare UPIN
TX003614701Medicaid