Healthcare Provider Details

I. General information

NPI: 1225706039
Provider Name (Legal Business Name): LINDA KAREN IMMLER M.S., CCC/SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KAREN DOSS IMMLER M.S., CCC/SLP

II. Dates (important events)

Enumeration Date: 09/06/2021
Last Update Date: 09/06/2021
Certification Date: 09/06/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

710 S CEDAR RIDGE DR
DUNCANVILLE TX
75137-2204
US

IV. Provider business mailing address

5601 S 14TH ST
MIDLOTHIAN TX
76065-2441
US

V. Phone/Fax

Practice location:
  • Phone: 972-708-2060
  • Fax: 972-708-2093
Mailing address:
  • Phone: 214-364-9278
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number16057
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: