Healthcare Provider Details

I. General information

NPI: 1912298613
Provider Name (Legal Business Name): PUZZLE PIECE KIDS PEDIATRIC THERAPIES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/28/2011
Last Update Date: 04/28/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4925 GREENVILLE AVE SUITE 200
DALLAS TX
75206-4026
US

IV. Provider business mailing address

4925 GREENVILLE AVE SUITE 200
DALLAS TX
75206-4026
US

V. Phone/Fax

Practice location:
  • Phone: 214-988-5437
  • Fax: 972-552-2152
Mailing address:
  • Phone: 214-988-5437
  • Fax: 972-552-2152

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number105978
License Number StateTX

VIII. Authorized Official

Name: MRS. NATALIE JONES EVANS
Title or Position: CEO/SPEECH-LANGUAGE PATHOLOGIST
Credential: M.S.,CCC-SLP
Phone: 214-625-2218