1437865722 NPI number — UTLEY SPEECH THERAPY, PLLC

Table of content: MS. MICHELLE ANN BROZOWSKI MS, ATC (NPI 1679616247)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1437865722 NPI number — UTLEY SPEECH THERAPY, PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
UTLEY SPEECH THERAPY, PLLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1437865722
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/01/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1342
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CASTROVILLE
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
78009-1342
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
210-570-7272
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
11906 KUDU ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SAN ANTONIO
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78253-5842
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
361-945-4401
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/30/2023

Additional Information

Authorized Official

Authorized Official Last Name:
UTLEY-RODRIGUEZ
Authorized Official First Name:
OLGA
Authorized Official Middle Name:
ANN
Authorized Official Title or Position:
OWNER/SPEECH PATHOLOGIST
Authorized Official Telephone Number:
361-945-4401

Provider Taxonomy Codes

  • Taxonomy code: 235Z00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 15589133 . This is a "CAQH" identifier . This identifiers is of the category "OTHER".
  • Identifier: 14157997 . This is a "(ASHA) AMERICAN SPEECH-LANGUAGE /HEARING ASSOCIATION" identifier . This identifiers is of the category "OTHER".
  • Identifier: 114048 . This is a "TEXAS DEPARTMENT OF REGULATORY SERVICES" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




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