Provider Demographics
NPI:1962715706
Name:MI CASA SPEECH AND LANGUAGE THERAPY
Entity type:Organization
Organization Name:MI CASA SPEECH AND LANGUAGE THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARY
Authorized Official - Middle Name:ANNE
Authorized Official - Last Name:NERICCIO
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:512-909-1684
Mailing Address - Street 1:2509 TOULOUSE DR
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78748-6049
Mailing Address - Country:US
Mailing Address - Phone:512-909-1684
Mailing Address - Fax:
Practice Address - Street 1:2509 TOULOUSE DR
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78748-6049
Practice Address - Country:US
Practice Address - Phone:512-909-1684
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-07-21
Last Update Date:2010-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX10310235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1376668863OtherPERSONAL NPI