Provider Demographics
NPI:1902785223
Name:HERNANDEZ, MAYRA (CCC-SLP)
Entity type:Individual
Prefix:
First Name:MAYRA
Middle Name:
Last Name:HERNANDEZ
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:338 HORTUS DR
Mailing Address - Street 2:
Mailing Address - City:KYLE
Mailing Address - State:TX
Mailing Address - Zip Code:78640-3225
Mailing Address - Country:US
Mailing Address - Phone:512-589-6079
Mailing Address - Fax:
Practice Address - Street 1:7601 DIXIE DR
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78744-7140
Practice Address - Country:US
Practice Address - Phone:512-414-2545
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-08-29
Last Update Date:2025-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX121652235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist