Healthcare Provider Details

I. General information

NPI: 1861832313
Provider Name (Legal Business Name): SPEAK FOR YOURSELF
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/28/2013
Last Update Date: 06/28/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12730 BEDELL BRIDGE LN
HUMBLE TX
77346-1136
US

IV. Provider business mailing address

12730 BEDELL BRIDGE LN
HUMBLE TX
77346-1136
US

V. Phone/Fax

Practice location:
  • Phone: 281-684-1818
  • Fax: 832-200-2266
Mailing address:
  • Phone: 281-684-1818
  • Fax: 832-200-2266

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number107087
License Number StateTX

VIII. Authorized Official

Name: JENNIFER MARIE MATT
Title or Position: OWNER
Credential: M.S., CCC-SLP
Phone: 281-684-1818