Provider Demographics
NPI:1750278701
Name:DE LA TORRE, PATRICIA MELISSA (SLP)
Entity type:Individual
Prefix:
First Name:PATRICIA
Middle Name:MELISSA
Last Name:DE LA TORRE
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 1:10350 BLUE BLUFF RD APT 3104
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78724-7060
Mailing Address - Country:US
Mailing Address - Phone:786-920-2853
Mailing Address - Fax:
Practice Address - Street 1:1505 W KOENIG LN
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78756-1415
Practice Address - Country:US
Practice Address - Phone:512-480-9573
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-06-23
Last Update Date:2025-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX123810235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist