Provider Demographics
NPI:1356713671
Name:SRN SPEECH THERAPY, PC
Entity type:Organization
Organization Name:SRN SPEECH THERAPY, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/ SPEECH LANGUAGE PATHOLOG
Authorized Official - Prefix:MR
Authorized Official - First Name:SERGIO
Authorized Official - Middle Name:RUBEN
Authorized Official - Last Name:NAVARRETE
Authorized Official - Suffix:
Authorized Official - Credentials:MS CCC-SLP
Authorized Official - Phone:915-329-9723
Mailing Address - Street 1:6058 VIA DE LOS ARBOLES
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79932-1829
Mailing Address - Country:US
Mailing Address - Phone:915-629-7663
Mailing Address - Fax:915-629-7673
Practice Address - Street 1:6058 VIA DE LOS ARBOLES
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79932-1829
Practice Address - Country:US
Practice Address - Phone:915-629-7663
Practice Address - Fax:915-629-7673
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-10-26
Last Update Date:2015-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX4021235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty