Provider Demographics
NPI:1588136253
Name:AUDREY DESPAIN, M.S., CCC-SLP, PLLC
Entity type:Organization
Organization Name:AUDREY DESPAIN, M.S., CCC-SLP, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SPEECH LANGUAGE PATHOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:AUDREY
Authorized Official - Middle Name:
Authorized Official - Last Name:DESPAIN
Authorized Official - Suffix:
Authorized Official - Credentials:MS, CCC-SLP
Authorized Official - Phone:361-362-4122
Mailing Address - Street 1:4601 BEGONIA ST
Mailing Address - Street 2:
Mailing Address - City:VICTORIA
Mailing Address - State:TX
Mailing Address - Zip Code:77904-2133
Mailing Address - Country:US
Mailing Address - Phone:361-362-4122
Mailing Address - Fax:361-288-7200
Practice Address - Street 1:4601 BEGONIA ST
Practice Address - Street 2:
Practice Address - City:VICTORIA
Practice Address - State:TX
Practice Address - Zip Code:77904-2133
Practice Address - Country:US
Practice Address - Phone:361-362-4122
Practice Address - Fax:361-288-7200
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-12-19
Last Update Date:2022-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty