Provider Demographics
NPI:1336871482
Name:PALACIOS, SELINA MARTINEZ (MS, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:SELINA
Middle Name:MARTINEZ
Last Name:PALACIOS
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 1:12112 PATTON PT
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78254-6215
Mailing Address - Country:US
Mailing Address - Phone:956-827-2911
Mailing Address - Fax:
Practice Address - Street 1:2203 BABCOCK RD
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78229-4412
Practice Address - Country:US
Practice Address - Phone:210-614-3911
Practice Address - Fax:210-625-3162
Is Sole Proprietor?:No
Enumeration Date:2022-06-28
Last Update Date:2022-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX116055235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist