Provider Demographics
NPI:1780015339
Name:CAPITAL AREA SPEECH THERAPY, PLLC
Entity Type:Organization
Organization Name:CAPITAL AREA SPEECH THERAPY, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINIC OWNER/DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:JAMIE
Authorized Official - Middle Name:L
Authorized Official - Last Name:PUTNAM
Authorized Official - Suffix:
Authorized Official - Credentials:MS,CCC/SLP
Authorized Official - Phone:512-924-9433
Mailing Address - Street 1:12710 RESEARCH BLVD STE 395
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78759-4397
Mailing Address - Country:US
Mailing Address - Phone:800-280-4316
Mailing Address - Fax:800-280-4316
Practice Address - Street 1:12710 RESEARCH BLVD STE 395
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78759-4397
Practice Address - Country:US
Practice Address - Phone:800-280-4316
Practice Address - Fax:800-280-4316
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-12-09
Last Update Date:2013-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty