Provider Demographics
NPI:1659536928
Name:LEON, PHILOMENA (SLP)
Entity Type:Individual
Prefix:
First Name:PHILOMENA
Middle Name:
Last Name:LEON
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 1:4161 E HIGHWAY 290
Mailing Address - Street 2:SUITE 400
Mailing Address - City:DRIPPING SPRINGS
Mailing Address - State:TX
Mailing Address - Zip Code:78620-4446
Mailing Address - Country:US
Mailing Address - Phone:512-858-9580
Mailing Address - Fax:512-858-9582
Practice Address - Street 1:1360 N LEE TREVINO DR
Practice Address - Street 2:SUITE 406
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79936-6400
Practice Address - Country:US
Practice Address - Phone:915-591-3336
Practice Address - Fax:915-975-8168
Is Sole Proprietor?:No
Enumeration Date:2008-07-25
Last Update Date:2008-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX18665235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist