Provider Demographics
NPI:1780816538
Name:ESCAMILLA-RODRIGUEZ, MARY LOU (ASLP)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:LOU
Last Name:ESCAMILLA-RODRIGUEZ
Suffix:
Gender:F
Credentials:ASLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:409 N GLASSCOCK RD
Mailing Address - Street 2:
Mailing Address - City:MISSION
Mailing Address - State:TX
Mailing Address - Zip Code:78572-8690
Mailing Address - Country:US
Mailing Address - Phone:956-316-2224
Mailing Address - Fax:956-316-1717
Practice Address - Street 1:2715 W TRENTON RD
Practice Address - Street 2:
Practice Address - City:EDINBURG
Practice Address - State:TX
Practice Address - Zip Code:78539-3433
Practice Address - Country:US
Practice Address - Phone:956-683-1155
Practice Address - Fax:956-683-1188
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-12
Last Update Date:2009-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX312892355S0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX149229001Medicaid