Provider Demographics
NPI:1952567331
Name:RALSON, AILEEN ELIZABETH (MS CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:AILEEN
Middle Name:ELIZABETH
Last Name:RALSON
Suffix:
Gender:F
Credentials:MS CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:348 LEISURE LN
Mailing Address - Street 2:
Mailing Address - City:COPPELL
Mailing Address - State:TX
Mailing Address - Zip Code:75019-2538
Mailing Address - Country:US
Mailing Address - Phone:903-918-0830
Mailing Address - Fax:
Practice Address - Street 1:348 LEISURE LN
Practice Address - Street 2:
Practice Address - City:COPPELL
Practice Address - State:TX
Practice Address - Zip Code:75019-2538
Practice Address - Country:US
Practice Address - Phone:903-918-0830
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-05
Last Update Date:2010-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX104097235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX80T580OtherBLUE CROSS BLUE SHIELD
TX207035101Medicaid