Provider Demographics
NPI:1356059760
Name:SPEECH PATHWAYS THERAPY CENTER LLC
Entity type:Organization
Organization Name:SPEECH PATHWAYS THERAPY CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SPEECH-LANGUAGE PATHOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:LETICIA
Authorized Official - Middle Name:ADILENE
Authorized Official - Last Name:CANCHOLA
Authorized Official - Suffix:
Authorized Official - Credentials:MS, CCC-SLP
Authorized Official - Phone:830-331-4128
Mailing Address - Street 1:17350 STATE HIGHWAY 249 STE 22012213
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77064-1147
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:136 OLD SAN ANTONIO RD STE 104
Practice Address - Street 2:
Practice Address - City:BOERNE
Practice Address - State:TX
Practice Address - Zip Code:78006-3338
Practice Address - Country:US
Practice Address - Phone:830-331-4128
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-11-14
Last Update Date:2022-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty