Provider Demographics
NPI:1255030854
Name:DIVERSE SPEECH THERAPY SOLUTIONS, LLC
Entity type:Organization
Organization Name:DIVERSE SPEECH THERAPY SOLUTIONS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SPEECH-LANGUAGE PATHOLOGIST/COOWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:VERONICA
Authorized Official - Middle Name:LEAL
Authorized Official - Last Name:BOTELLO
Authorized Official - Suffix:
Authorized Official - Credentials:MA CCC-SLP
Authorized Official - Phone:210-829-5777
Mailing Address - Street 1:1600 NE LOOP 410 STE 226
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78209-1634
Mailing Address - Country:US
Mailing Address - Phone:210-829-5777
Mailing Address - Fax:
Practice Address - Street 1:1600 NE LOOP 410 STE 226
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78209-1634
Practice Address - Country:US
Practice Address - Phone:210-829-5777
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-03-02
Last Update Date:2023-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty