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Organization

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Active
Organization subpart
No

Provider details

NPI number
Authorized official
MRS. LISA LONGORIA MA, CCC/SLP (SPEECH-LANGUAGE PATHOLOGIST)
(210) 519-7834
Entity
Organization

Contact information

Practice address
16714 HUNTING VLY, SAN ANTONIO, TX 78247-1056
(210) 519-7834
(210) 590-3890
Mailing address
16714 HUNTING VLY, SAN ANTONIO, TX 78247-1056
(210) 519-7834
(210) 590-3890

Taxonomy

Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
18804
TX

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
211081901
TX
Enumeration date
04/26/2011
Last updated
04/26/2011
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