Provider Demographics
NPI:1942569934
Name:ADULT SWALLOW, SPEECH AND LANGUAGE SPECIALTY CLINIC
Entity Type:Organization
Organization Name:ADULT SWALLOW, SPEECH AND LANGUAGE SPECIALTY CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:LARRY
Authorized Official - Middle Name:
Authorized Official - Last Name:HOELTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:956-279-4508
Mailing Address - Street 1:817 N WARE RD
Mailing Address - Street 2:STE 20
Mailing Address - City:MCALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:78501-6611
Mailing Address - Country:US
Mailing Address - Phone:956-800-4628
Mailing Address - Fax:
Practice Address - Street 1:817 N WARE RD
Practice Address - Street 2:STE 20
Practice Address - City:MCALLEN
Practice Address - State:TX
Practice Address - Zip Code:78501-6611
Practice Address - Country:US
Practice Address - Phone:956-800-4628
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-10
Last Update Date:2012-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX19042235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty