Provider Demographics
NPI:1235977612
Name:CAVAZOS, BIANCA (SLP ASSISTANT)
Entity type:Individual
Prefix:
First Name:BIANCA
Middle Name:
Last Name:CAVAZOS
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 1:15435 RIVER BND
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78247-2918
Mailing Address - Country:US
Mailing Address - Phone:210-601-8265
Mailing Address - Fax:
Practice Address - Street 1:12000 NETWORK BLVD STE 105A
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78249-3344
Practice Address - Country:US
Practice Address - Phone:915-444-0945
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-18
Last Update Date:2024-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX328212355S0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant