Provider Demographics
NPI:1457127813
Name:MIRELES, MAKAYLA LOREN (SLP CFY)
Entity Type:Individual
Prefix:
First Name:MAKAYLA
Middle Name:LOREN
Last Name:MIRELES
Suffix:
Gender:F
Credentials:SLP CFY
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14811 WILLOW BND
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78232-4514
Mailing Address - Country:US
Mailing Address - Phone:210-473-6524
Mailing Address - Fax:
Practice Address - Street 1:8961 TESORO DR
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78217-6209
Practice Address - Country:US
Practice Address - Phone:210-407-4632
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-11-28
Last Update Date:2023-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX121135235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist