Healthcare Provider Details

I. General information

NPI: 1538842935
Provider Name (Legal Business Name): MCKAYLA VOLLMERING
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/11/2023
Last Update Date: 08/11/2023
Certification Date: 08/11/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

103 SCHMIDT
ORANGE GROVE TX
78372-9169
US

IV. Provider business mailing address

103 SCHMIDT
ORANGE GROVE TX
78372-9169
US

V. Phone/Fax

Practice location:
  • Phone: 956-821-7720
  • Fax:
Mailing address:
  • Phone: 956-821-7720
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2355S0801X
TaxonomySpeech-Language Assistant
License Number43035
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: