Provider Demographics
NPI:1679053276
Name:TREVINO, NORMA ALICIA (SLP ASSISTANT BS)
Entity Type:Individual
Prefix:MS
First Name:NORMA
Middle Name:ALICIA
Last Name:TREVINO
Suffix:
Gender:F
Credentials:SLP ASSISTANT BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2010 REDSKIN AVE STE B
Mailing Address - Street 2:
Mailing Address - City:DONNA
Mailing Address - State:TX
Mailing Address - Zip Code:78537-3380
Mailing Address - Country:US
Mailing Address - Phone:956-461-2309
Mailing Address - Fax:
Practice Address - Street 1:2010 REDSKIN AVE STE A
Practice Address - Street 2:
Practice Address - City:DONNA
Practice Address - State:TX
Practice Address - Zip Code:78537-3380
Practice Address - Country:US
Practice Address - Phone:956-461-2309
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-14
Last Update Date:2018-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX366392355S0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1780619031Medicaid