Provider Demographics
NPI:1699438838
Name:LIFESPAN SPEECH AND SWALLOW THERAPY PLLC
Entity type:Organization
Organization Name:LIFESPAN SPEECH AND SWALLOW THERAPY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/SPEECH PATHOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:KATHERIN
Authorized Official - Middle Name:
Authorized Official - Last Name:OIGBOKIE
Authorized Official - Suffix:
Authorized Official - Credentials:SLP
Authorized Official - Phone:210-876-5282
Mailing Address - Street 1:20658 STONE OAK PKWY UNIT 101
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78258-7361
Mailing Address - Country:US
Mailing Address - Phone:210-876-5282
Mailing Address - Fax:210-864-2199
Practice Address - Street 1:20658 STONE OAK PKWY UNIT 101
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78258-7361
Practice Address - Country:US
Practice Address - Phone:210-876-5282
Practice Address - Fax:210-864-2199
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-10-14
Last Update Date:2023-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX4310906Medicaid