Provider Demographics
NPI:1821173816
Name:LAZCANO, AMANDA M (SLP)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:M
Last Name:LAZCANO
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 1:3454 BURGUNDY DR
Mailing Address - Street 2:
Mailing Address - City:BROWNSVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78526-1136
Mailing Address - Country:US
Mailing Address - Phone:956-982-1191
Mailing Address - Fax:
Practice Address - Street 1:302 KINGS HWY STE 208
Practice Address - Street 2:
Practice Address - City:BROWNSVILLE
Practice Address - State:TX
Practice Address - Zip Code:78521-4225
Practice Address - Country:US
Practice Address - Phone:956-550-8200
Practice Address - Fax:956-550-8133
Is Sole Proprietor?:No
Enumeration Date:2006-10-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX18774235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8T3165OtherBCBS OF TEXAS