Healthcare Provider Details

I. General information

NPI: 1578335329
Provider Name (Legal Business Name): JENNIFER VALLELY BOSCO SLPA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/25/2023
Last Update Date: 10/25/2023
Certification Date: 10/25/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1112 E COPELAND RD STE 300
ARLINGTON TX
76011-4910
US

IV. Provider business mailing address

13400 BRIARWICK DR UNIT 1402
AUSTIN TX
78729-1771
US

V. Phone/Fax

Practice location:
  • Phone: 817-505-2575
  • Fax:
Mailing address:
  • Phone: 903-316-2390
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2355S0801X
TaxonomySpeech-Language Assistant
License Number43091
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: