Provider Demographics
NPI:1306502489
Name:ALVARADO, CELENE
Entity type:Individual
Prefix:
First Name:CELENE
Middle Name:
Last Name:ALVARADO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2000 EAGLE AERIE LN
Mailing Address - Street 2:
Mailing Address - City:ST PAUL
Mailing Address - State:TX
Mailing Address - Zip Code:75098-0259
Mailing Address - Country:US
Mailing Address - Phone:972-429-2600
Mailing Address - Fax:
Practice Address - Street 1:2000 EAGLE AERIE LN
Practice Address - Street 2:
Practice Address - City:ST PAUL
Practice Address - State:TX
Practice Address - Zip Code:75098-0259
Practice Address - Country:US
Practice Address - Phone:972-429-2600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-11-12
Last Update Date:2022-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX118671235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX34118128Medicaid