Provider Demographics
NPI:1871522771
Name:UNIVERSITY OF TEXAS AT AUSTIN
Entity type:Organization
Organization Name:UNIVERSITY OF TEXAS AT AUSTIN
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CHAIR
Authorized Official - Prefix:
Authorized Official - First Name:CRAIG
Authorized Official - Middle Name:A
Authorized Official - Last Name:CHAMPLIN
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:512-471-6345
Mailing Address - Street 1:1 UNIVERSITY STATION A1100
Mailing Address - Street 2:1 UNIVERSITY STATION A1100 CMA 2200
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78712
Mailing Address - Country:US
Mailing Address - Phone:512-471-3841
Mailing Address - Fax:512-232-1804
Practice Address - Street 1:2504 A WHITIS
Practice Address - Street 2:2504 A WHITIS CMA 2200
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78712
Practice Address - Country:US
Practice Address - Phone:512-471-3841
Practice Address - Fax:512-232-1804
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered231H00000XSpeech, Language and Hearing Service ProvidersAudiologistGroup - Multi-Specialty
Not Answered235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
0009BTOtherBCBS