Provider Demographics
NPI:1841654290
Name:RAU, AMELIA MEDINA (PHD/MS CCC-SLP)
Entity type:Individual
Prefix:DR
First Name:AMELIA
Middle Name:MEDINA
Last Name:RAU
Suffix:
Gender:F
Credentials:PHD/MS CCC-SLP
Other - Prefix:DR
Other - First Name:AMELIA
Other - Middle Name:
Other - Last Name:MEDINA RAU
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHD/MSCCC-SLP
Mailing Address - Street 1:7256 SHIRE WAY
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79912-1516
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:7256 SHIRE WAY
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79912-1516
Practice Address - Country:US
Practice Address - Phone:575-646-2348
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-12
Last Update Date:2018-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM4882235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX113153OtherTX LICENSE