Provider Demographics
NPI:1659016970
Name:MAGALLANES, DORA ORALIA (SLP)
Entity Type:Individual
Prefix:
First Name:DORA
Middle Name:ORALIA
Last Name:MAGALLANES
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 1:7585 KITTY HAWK RD STE 202
Mailing Address - Street 2:
Mailing Address - City:CONVERSE
Mailing Address - State:TX
Mailing Address - Zip Code:78109-2820
Mailing Address - Country:US
Mailing Address - Phone:210-236-0911
Mailing Address - Fax:210-899-0912
Practice Address - Street 1:7585 KITTY HAWK RD STE 202
Practice Address - Street 2:
Practice Address - City:CONVERSE
Practice Address - State:TX
Practice Address - Zip Code:78109-2820
Practice Address - Country:US
Practice Address - Phone:210-236-0911
Practice Address - Fax:210-899-0912
Is Sole Proprietor?:No
Enumeration Date:2022-05-02
Last Update Date:2022-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX119410235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist