Provider Demographics
NPI:1457764326
Name:URDIALES, PRISCILLA ANN (MA, CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:PRISCILLA
Middle Name:ANN
Last Name:URDIALES
Suffix:
Gender:F
Credentials:MA, CCC-SLP
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Other - First Name:
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Mailing Address - Street 1:98 BRIGGS ST
Mailing Address - Street 2:SUITE 990
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78224-1286
Mailing Address - Country:US
Mailing Address - Phone:210-226-9536
Mailing Address - Fax:210-924-3376
Practice Address - Street 1:98 BRIGGS ST
Practice Address - Street 2:SUITE 990
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78224-1286
Practice Address - Country:US
Practice Address - Phone:210-226-9536
Practice Address - Fax:210-924-3376
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-08
Last Update Date:2016-06-20
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TX103618235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist