Healthcare Provider Details

I. General information

NPI: 1669664991
Provider Name (Legal Business Name): NANCY BEWLEY M.A.T CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/10/2007
Last Update Date: 08/10/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11001 HAMMERLY BLVD
HOUSTON TX
77043-1913
US

IV. Provider business mailing address

11001 HAMMERLY BLVD
HOUSTON TX
77043-1913
US

V. Phone/Fax

Practice location:
  • Phone: 713-467-4696
  • Fax: 713-467-8341
Mailing address:
  • Phone: 713-467-4696
  • Fax: 713-467-8341

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number15925
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: