Provider Demographics
NPI:1952020687
Name:OUR LADY OF THE LAKE UNIVERSITY SAN ANTONIO
Entity Type:Organization
Organization Name:OUR LADY OF THE LAKE UNIVERSITY SAN ANTONIO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SCHOOL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:PATTI
Authorized Official - Middle Name:L
Authorized Official - Last Name:SOLOMON-RICE
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:210-528-6772
Mailing Address - Street 1:WOOLFOLK SCHOOL OF COMMUNCATION SCIENCES AND DISORDERS
Mailing Address - Street 2:411 SW 24TH ST
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78207
Mailing Address - Country:US
Mailing Address - Phone:210-431-3938
Mailing Address - Fax:210-434-9360
Practice Address - Street 1:5210 THOUSAND OAKS DR
Practice Address - Street 2:SUITE 1246
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78233
Practice Address - Country:US
Practice Address - Phone:210-436-8050
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:OUR LADY OF THE LAKE UNIVERSITY SAN A
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2022-08-25
Last Update Date:2022-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologistGroup - Multi-Specialty
No235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty