Provider Demographics
NPI:1992151419
Name:CISNEROS, LINA (SLP-ASSISTANT)
Entity type:Individual
Prefix:
First Name:LINA
Middle Name:
Last Name:CISNEROS
Suffix:
Gender:F
Credentials:SLP-ASSISTANT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:309 MESA CT
Mailing Address - Street 2:
Mailing Address - City:GLENN HEIGHTS
Mailing Address - State:TX
Mailing Address - Zip Code:75154-8518
Mailing Address - Country:US
Mailing Address - Phone:210-414-5101
Mailing Address - Fax:
Practice Address - Street 1:132 E OVILLA RD STE A
Practice Address - Street 2:
Practice Address - City:RED OAK
Practice Address - State:TX
Practice Address - Zip Code:75154-2460
Practice Address - Country:US
Practice Address - Phone:469-850-5433
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-05-13
Last Update Date:2021-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX387812355S0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant