Provider Demographics
NPI:1891674834
Name:EUBANKS, MIKAYLA RAE (MA, CCC-SLP)
Entity type:Individual
Prefix:
First Name:MIKAYLA
Middle Name:RAE
Last Name:EUBANKS
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:MIKAYLA
Other - Middle Name:RAE EUBANKS
Other - Last Name:DEAVENPORT
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MA CCC-SLP
Mailing Address - Street 1:7720 OCONNOR DR APT 3013
Mailing Address - Street 2:
Mailing Address - City:ROUND ROCK
Mailing Address - State:TX
Mailing Address - Zip Code:78681-5577
Mailing Address - Country:US
Mailing Address - Phone:325-315-8753
Mailing Address - Fax:
Practice Address - Street 1:3610 WILLIAMS DR
Practice Address - Street 2:
Practice Address - City:GEORGETOWN
Practice Address - State:TX
Practice Address - Zip Code:78628-2420
Practice Address - Country:US
Practice Address - Phone:512-256-7627
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-09-02
Last Update Date:2025-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX123046235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist