Organization
LANGUAGE & MOVEMENT
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JENNY MATTHEWS BA, SPEECH PATHOLOGY (CEO)
(512) 451-0961
Entity
Organization
Contact information
Practice address
111 W ANDERSON LANE, SUITE C-100, AUSTIN, TX 78752-1119
(512) 451-0961
(512) 451-9745
Mailing address
PO BOX 15024, AUSTIN, TX 78761-5024
(512) 451-0961
(512) 451-9745
Taxonomy
Speciality
Code
Description
License number
State
261QD1600X
Developmental Disabilities Clinic/Center
0056CM
TX
261QD1600X
Developmental Disabilities Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0056CM
BCBS PROVIDER ID
TX
Enumeration date
09/20/2006
Last updated
07/25/2012
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