Healthcare Provider Details

I. General information

NPI: 1104026947
Provider Name (Legal Business Name): TESSA SEXTON M.S., CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/19/2007
Last Update Date: 07/19/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1318 MEMORIAL DR
BRYAN TX
77802-5215
US

IV. Provider business mailing address

1318 MEMORIAL DR
BRYAN TX
77802-5215
US

V. Phone/Fax

Practice location:
  • Phone: 979-776-6268
  • Fax: 979-776-1456
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number103536
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: