Provider Demographics
NPI:1124646880
Name:ESCOBAR, ESTEFANIA (MS, CCC-SLP, BCABA)
Entity type:Individual
Prefix:
First Name:ESTEFANIA
Middle Name:
Last Name:ESCOBAR
Suffix:
Gender:F
Credentials:MS, CCC-SLP, BCABA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7130 BIRCH VIEW CT
Mailing Address - Street 2:
Mailing Address - City:FLOWERY BRANCH
Mailing Address - State:GA
Mailing Address - Zip Code:30542-3313
Mailing Address - Country:US
Mailing Address - Phone:786-397-0034
Mailing Address - Fax:
Practice Address - Street 1:500 SPRING ST SE
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:GA
Practice Address - Zip Code:30501-3773
Practice Address - Country:US
Practice Address - Phone:786-397-0034
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-09
Last Update Date:2024-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
0-21-12733106E00000X
NMSAH-2024-0265235Z00000X
GASLP013145235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
No106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior Analyst