Provider Demographics
NPI:1790966448
Name:ELIZONDO, SAMANTHA JOY (MS, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:JOY
Last Name:ELIZONDO
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 S AGUIRRE ST
Mailing Address - Street 2:
Mailing Address - City:RIO GRANDE CITY
Mailing Address - State:TX
Mailing Address - Zip Code:78582-4808
Mailing Address - Country:US
Mailing Address - Phone:956-533-6566
Mailing Address - Fax:
Practice Address - Street 1:1313 S CLOSNER BLVD
Practice Address - Street 2:SUITE B
Practice Address - City:EDINBURG
Practice Address - State:TX
Practice Address - Zip Code:78539-5665
Practice Address - Country:US
Practice Address - Phone:956-289-8441
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-11-23
Last Update Date:2007-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX103022235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist