Provider Demographics
NPI:1871004903
Name:GREATER AUSTIN SPEECH AND LANGUAGE THERAPY, PLLC
Entity type:Organization
Organization Name:GREATER AUSTIN SPEECH AND LANGUAGE THERAPY, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KAITING
Authorized Official - Middle Name:
Authorized Official - Last Name:BRONSON
Authorized Official - Suffix:
Authorized Official - Credentials:MS, CCC/SLP
Authorized Official - Phone:737-888-1024
Mailing Address - Street 1:6000 SHEPHERD MOUNTAIN CV UNIT 1004
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78730-4904
Mailing Address - Country:US
Mailing Address - Phone:737-888-1024
Mailing Address - Fax:512-233-0693
Practice Address - Street 1:16800 ENNIS TRL
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78717-5506
Practice Address - Country:US
Practice Address - Phone:737-888-1024
Practice Address - Fax:512-233-0693
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-10-16
Last Update Date:2017-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty