Provider Demographics
NPI:1790251262
Name:DE OLIVEIRA, ENIO CLARK (SLP)
Entity Type:Individual
Prefix:
First Name:ENIO
Middle Name:CLARK
Last Name:DE OLIVEIRA
Suffix:
Gender:M
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24543 SPRINGWOOD GLEN LN
Mailing Address - Street 2:
Mailing Address - City:KATY
Mailing Address - State:TX
Mailing Address - Zip Code:77494-5049
Mailing Address - Country:US
Mailing Address - Phone:832-977-7606
Mailing Address - Fax:
Practice Address - Street 1:2600 N GESSNER RD ST 236
Practice Address - Street 2:ST 236
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77080-7708
Practice Address - Country:US
Practice Address - Phone:832-977-7606
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-22
Last Update Date:2021-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX113722235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX179025262OtherNPI