Provider Demographics
NPI:1861765265
Name:AUSTIN AREA SPEECH & LANGUAGE SERVICES
Entity type:Organization
Organization Name:AUSTIN AREA SPEECH & LANGUAGE SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SPEECH-LANGUAGE PATHOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:SUSANNE
Authorized Official - Middle Name:SCHLANKEY
Authorized Official - Last Name:DEJERNETT
Authorized Official - Suffix:
Authorized Official - Credentials:MA, CCC-SLP
Authorized Official - Phone:512-327-2083
Mailing Address - Street 1:3103 BEE CAVES RD
Mailing Address - Street 2:SUITE 104
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78746-5586
Mailing Address - Country:US
Mailing Address - Phone:512-327-2083
Mailing Address - Fax:512-327-0808
Practice Address - Street 1:3103 BEE CAVES RD
Practice Address - Street 2:SUITE 104
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78746-5586
Practice Address - Country:US
Practice Address - Phone:512-327-2083
Practice Address - Fax:512-327-0808
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-15
Last Update Date:2016-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX17743235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX2051690Medicaid