Provider Demographics
NPI:1457101610
Name:ACADEMIC BASED COMMUNICATION THERAPY, PLLC
Entity Type:Organization
Organization Name:ACADEMIC BASED COMMUNICATION THERAPY, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SPEECH-LANGUAGE PATHOLOGIST/OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:ANA
Authorized Official - Middle Name:TERESA
Authorized Official - Last Name:CANALES
Authorized Official - Suffix:
Authorized Official - Credentials:MS, CCC-SLP
Authorized Official - Phone:361-522-7866
Mailing Address - Street 1:3659 ANGELITA DR
Mailing Address - Street 2:
Mailing Address - City:ODEM
Mailing Address - State:TX
Mailing Address - Zip Code:78370-4435
Mailing Address - Country:US
Mailing Address - Phone:361-522-7866
Mailing Address - Fax:
Practice Address - Street 1:3361 COUNTY ROAD 48
Practice Address - Street 2:
Practice Address - City:ROBSTOWN
Practice Address - State:TX
Practice Address - Zip Code:78380-6014
Practice Address - Country:US
Practice Address - Phone:361-522-7866
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-03-22
Last Update Date:2024-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty