Provider Demographics
NPI:1861662355
Name:CAROMATA, CECILIA ANGEL (MA CCC-SLP)
Entity Type:Individual
Prefix:
First Name:CECILIA
Middle Name:ANGEL
Last Name:CAROMATA
Suffix:
Gender:F
Credentials:MA CCC-SLP
Other - Prefix:
Other - First Name:CECILIA
Other - Middle Name:ANGEL
Other - Last Name:PALACIOS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2525 WALLINGWOOD DR
Mailing Address - Street 2:BUILDING 2
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78746-6900
Mailing Address - Country:US
Mailing Address - Phone:512-327-6179
Mailing Address - Fax:512-327-1545
Practice Address - Street 1:2525 WALLINGWOOD DR
Practice Address - Street 2:BUILDING 2
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78746-6900
Practice Address - Country:US
Practice Address - Phone:512-327-6179
Practice Address - Fax:512-327-1545
Is Sole Proprietor?:No
Enumeration Date:2008-03-11
Last Update Date:2013-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX103379235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX203125401Medicaid