Provider Demographics
NPI:1902429913
Name:LIBERATO, ALEXIS ESPINAL (CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:ALEXIS
Middle Name:ESPINAL
Last Name:LIBERATO
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3030 NACOGDOCHES RD STE 108
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78217-4502
Mailing Address - Country:US
Mailing Address - Phone:830-570-4492
Mailing Address - Fax:
Practice Address - Street 1:3030 NACOGDOCHES RD STE 108
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78217-4502
Practice Address - Country:US
Practice Address - Phone:830-570-4492
Practice Address - Fax:210-568-4937
Is Sole Proprietor?:No
Enumeration Date:2020-05-26
Last Update Date:2024-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX117979235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist