Provider Demographics
NPI:1528699295
Name:BOTELLO, VERONICA LEAL (MA CCC-SLP)
Entity type:Individual
Prefix:
First Name:VERONICA
Middle Name:LEAL
Last Name:BOTELLO
Suffix:
Gender:F
Credentials:MA CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8800 BROADWAY STE 200
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78217-6356
Mailing Address - Country:US
Mailing Address - Phone:210-954-2492
Mailing Address - Fax:
Practice Address - Street 1:8800 BROADWAY
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78217-6335
Practice Address - Country:US
Practice Address - Phone:210-829-5777
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-01-30
Last Update Date:2023-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX102695235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist