Provider Demographics
NPI:1548743925
Name:BRESLIN, TALLULAH RACHEL (SLP)
Entity type:Individual
Prefix:
First Name:TALLULAH
Middle Name:RACHEL
Last Name:BRESLIN
Suffix:
Gender:X
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:701 WALSH HILL TRL
Mailing Address - Street 2:
Mailing Address - City:CEDAR PARK
Mailing Address - State:TX
Mailing Address - Zip Code:78613-4855
Mailing Address - Country:US
Mailing Address - Phone:512-649-3119
Mailing Address - Fax:855-933-2649
Practice Address - Street 1:701 WALSH HILL TRL
Practice Address - Street 2:
Practice Address - City:CEDAR PARK
Practice Address - State:TX
Practice Address - Zip Code:78613-4855
Practice Address - Country:US
Practice Address - Phone:512-649-3119
Practice Address - Fax:855-933-2649
Is Sole Proprietor?:No
Enumeration Date:2018-09-11
Last Update Date:2024-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI7101007562235Z00000X
TX111967235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist