Provider Demographics
NPI:1922209774
Name:RAMON, CLOTILDE (SLP)
Entity Type:Individual
Prefix:
First Name:CLOTILDE
Middle Name:
Last Name:RAMON
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 1:1110 S STEWART RD STE D
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:TX
Mailing Address - Zip Code:78589-5168
Mailing Address - Country:US
Mailing Address - Phone:956-283-7555
Mailing Address - Fax:956-283-7557
Practice Address - Street 1:1110 S. STEWART RD., STE.D
Practice Address - Street 2:STE
Practice Address - City:SAN JUAN
Practice Address - State:TX
Practice Address - Zip Code:78589
Practice Address - Country:US
Practice Address - Phone:956-283-7556
Practice Address - Fax:956-283-7557
Is Sole Proprietor?:No
Enumeration Date:2007-05-30
Last Update Date:2018-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX13007235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX13007Medicaid