Provider Demographics
NPI:1982917563
Name:EUSEBIO, ROSALIE MIZCLES (SLP)
Entity Type:Individual
Prefix:
First Name:ROSALIE
Middle Name:MIZCLES
Last Name:EUSEBIO
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:ROSALIE
Other - Middle Name:MIZCLES
Other - Last Name:EUSEBIO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:BS, MS
Mailing Address - Street 1:10104 BALLYMOTE DR
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79925-4327
Mailing Address - Country:US
Mailing Address - Phone:915-317-9716
Mailing Address - Fax:
Practice Address - Street 1:10104 BALLYMOTE DR
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79925-4327
Practice Address - Country:US
Practice Address - Phone:915-317-9716
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-23
Last Update Date:2012-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX149984001Medicaid
TX456606Medicare UPIN
TX676535Medicare UPIN