Provider Demographics
NPI:1649326943
Name:MUNSON, PATRICIA (SLP)
Entity type:Individual
Prefix:
First Name:PATRICIA
Middle Name:
Last Name:MUNSON
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:PATRICIA
Other - Middle Name:
Other - Last Name:TAMEZ-MUNSON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:5709 SPRINGFIELD AVE
Mailing Address - Street 2:
Mailing Address - City:LAREDO
Mailing Address - State:TX
Mailing Address - Zip Code:78041-3282
Mailing Address - Country:US
Mailing Address - Phone:956-728-1769
Mailing Address - Fax:956-722-1723
Practice Address - Street 1:5709 SPRINGFIELD AVE.
Practice Address - Street 2:
Practice Address - City:LAREDO
Practice Address - State:TX
Practice Address - Zip Code:78041-5434
Practice Address - Country:US
Practice Address - Phone:956-728-1769
Practice Address - Fax:956-722-1723
Is Sole Proprietor?:No
Enumeration Date:2007-01-27
Last Update Date:2015-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX17754235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX17754OtherLICENSE