Provider Demographics
NPI:1699906800
Name:OLMOS SPEECH, LANGUAGE, AND LEARNING CLINIC
Entity type:Organization
Organization Name:OLMOS SPEECH, LANGUAGE, AND LEARNING CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SPEECH LANGUAGE THERAPIST/PARTNER
Authorized Official - Prefix:MS
Authorized Official - First Name:BARBARA
Authorized Official - Middle Name:T
Authorized Official - Last Name:SYKES
Authorized Official - Suffix:
Authorized Official - Credentials:MA, MS, CCC-S
Authorized Official - Phone:210-828-5583
Mailing Address - Street 1:5800 BROADWAY ST
Mailing Address - Street 2:STE. 106
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78209-5265
Mailing Address - Country:US
Mailing Address - Phone:210-828-5583
Mailing Address - Fax:210-828-4129
Practice Address - Street 1:5800 BROADWAY ST
Practice Address - Street 2:STE. 106
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78209-5265
Practice Address - Country:US
Practice Address - Phone:210-828-5583
Practice Address - Fax:210-828-4129
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-08-05
Last Update Date:2009-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX11186235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty