Healthcare Provider Details

I. General information

NPI: 1447943204
Provider Name (Legal Business Name): DYSPHAGIA THERAPY PLUS CM, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/30/2023
Last Update Date: 10/06/2023
Certification Date: 10/06/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5445 ALMEDA RD STE 450
HOUSTON TX
77004-7403
US

IV. Provider business mailing address

5445 ALMEDA RD STE 450
HOUSTON TX
77004-7403
US

V. Phone/Fax

Practice location:
  • Phone: 832-622-4929
  • Fax: 713-673-5113
Mailing address:
  • Phone: 832-622-4929
  • Fax: 713-673-5113

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QH0700X
TaxonomyHearing and Speech Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: GILDA LETRICA JACK-JOHNSON
Title or Position: SPEECH-LANGUAGE PATHOLOGIST
Credential: M ED CCC/SLP
Phone: 832-622-4929