Provider Demographics
NPI:1265911598
Name:SANTANA, MARI CARMEN (BS, ASST-SLP)
Entity type:Individual
Prefix:
First Name:MARI
Middle Name:CARMEN
Last Name:SANTANA
Suffix:
Gender:F
Credentials:BS, ASST-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:703 E SANTA ANGELA ST
Mailing Address - Street 2:
Mailing Address - City:PHARR
Mailing Address - State:TX
Mailing Address - Zip Code:78577-9340
Mailing Address - Country:US
Mailing Address - Phone:956-617-5767
Mailing Address - Fax:
Practice Address - Street 1:1005 E 10TH ST
Practice Address - Street 2:
Practice Address - City:WESLACO
Practice Address - State:TX
Practice Address - Zip Code:78596-5127
Practice Address - Country:US
Practice Address - Phone:956-617-5767
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-08
Last Update Date:2018-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX349862355S0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant