Individual provider Active NPI

Eva M. Palacios, M.S., CCC/SLP

  • Speech-Language Pathologist
  • Waco, TX
National Provider Identifier
1932264264
Registry record updated Dec 1, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Speech-Language PathologistTaxonomy code 235Z00000X
License
17042 Issued in TX
Practice address
2124 N 25TH St
Waco, TX 76708-3317
Phone
(254) 235-2430
Fax
(254) 235-2434
NPI assigned
Dec 27, 2006
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Dec 1, 2011

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Speech-Language Pathologist 235Z00000X 17042 TX Primary

Addresses

Primary practice location

2124 N 25TH St
Waco, TX 76708-3317

Mailing address

2124 N 25TH St
Waco, TX 76708-3317
Phone (254) 235-2430

Other identifiers 1

IdentifierTypeStateIssuer
17042OtherTXSTATE LICENSE

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20201029000029 TX Practitioner - Qualified Speech Language Pathologist 5799195996 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Master of Science

State licenses

LicenseStateTypeSpecialty
17042TXMDMental Health Counselor

Practice roles

OrganizationSpecialtyStatusNew patients
Kids Therapy Specialties LLC Speech-Language Pathologist CurrentSince Jan 1, 2020 Accepting new patients

Locations

4900 Sanger Ave
Waco, TX 76710
Phone (254) 644-2423

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1167177600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1322697600000",
    "number": "1932264264",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2124 N 25TH ST",
            "city": "WACO",
            "state": "TX",
            "postal_code": "767083317",
            "telephone_number": "254-235-2430",
            "fax_number": "254-235-2434"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2124 N 25TH ST",
            "city": "WACO",
            "state": "TX",
            "postal_code": "767083317",
            "telephone_number": "254-235-2430",
            "fax_number": "254-235-2434"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PALACIOS",
        "first_name": "EVA",
        "middle_name": "M.",
        "credential": "M.S., CCC/SLP",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-12-27",
        "last_updated": "2011-12-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "TX",
            "license": "17042",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE LICENSE",
            "identifier": "17042",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Waco, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 1, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.