Healthcare Provider Details

I. General information

NPI: 1932836087
Provider Name (Legal Business Name): MAX JOSEPH PELL MS, CCC-SLP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/08/2022
Last Update Date: 08/08/2022
Certification Date: 08/08/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2601 EVANS AVE
FORT WORTH TX
76104-6817
US

IV. Provider business mailing address

100 N UNIVERSITY DR
FORT WORTH TX
76107-1360
US

V. Phone/Fax

Practice location:
  • Phone: 817-814-0600
  • Fax:
Mailing address:
  • Phone: 817-814-2000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number111683
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: