Provider Demographics
NPI:1932671195
Name:JUPSON, RONNI (MS CCC-SLP)
Entity Type:Individual
Prefix:
First Name:RONNI
Middle Name:
Last Name:JUPSON
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 1:3010 WINDSOR RD APT G
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78703-2360
Mailing Address - Country:US
Mailing Address - Phone:901-428-6769
Mailing Address - Fax:
Practice Address - Street 1:601 CAMP CRAFT RD
Practice Address - Street 2:
Practice Address - City:WEST LAKE HILLS
Practice Address - State:TX
Practice Address - Zip Code:78746-6511
Practice Address - Country:US
Practice Address - Phone:512-732-9000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-12-27
Last Update Date:2022-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX114034235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist