Provider Demographics
NPI:1548936768
Name:CANTU, OLIVA NICOLE (MS, CCC-SLP)
Entity type:Individual
Prefix:
First Name:OLIVA
Middle Name:NICOLE
Last Name:CANTU
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 1:1202 E SONTERRA BLVD STE 609
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78258-4093
Mailing Address - Country:US
Mailing Address - Phone:210-891-0800
Mailing Address - Fax:210-891-0888
Practice Address - Street 1:1202 E SONTERRA BLVD STE 609
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78258-4093
Practice Address - Country:US
Practice Address - Phone:210-891-0800
Practice Address - Fax:210-891-0888
Is Sole Proprietor?:No
Enumeration Date:2021-08-18
Last Update Date:2021-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX116014235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist