Provider Demographics
NPI:1760658975
Name:MONCIVAIS, SARAH REBECCAH (MS, CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:SARAH
Middle Name:REBECCAH
Last Name:MONCIVAIS
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:MS
Other - First Name:SARAH
Other - Middle Name:REBECCAH
Other - Last Name:DELEON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, CCC-SLP
Mailing Address - Street 1:1019 W HWY 83
Mailing Address - Street 2:P
Mailing Address - City:ALAMO
Mailing Address - State:TX
Mailing Address - Zip Code:78516-2530
Mailing Address - Country:US
Mailing Address - Phone:956-787-8255
Mailing Address - Fax:956-782-9977
Practice Address - Street 1:1019 W HWY 83
Practice Address - Street 2:P
Practice Address - City:ALAMO
Practice Address - State:TX
Practice Address - Zip Code:78516-2530
Practice Address - Country:US
Practice Address - Phone:956-787-8255
Practice Address - Fax:956-782-9977
Is Sole Proprietor?:No
Enumeration Date:2008-05-07
Last Update Date:2011-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX102817235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX215535001Medicaid