Healthcare Provider Details

I. General information

NPI: 1205183282
Provider Name (Legal Business Name): PANHANDLE SPEECH THERAPY SERVICES PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/09/2012
Last Update Date: 08/09/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

312 EUCLID AVE.
PANHANDLE TX
79068
US

IV. Provider business mailing address

PO BOX 216
PANHANDLE TX
79068-0216
US

V. Phone/Fax

Practice location:
  • Phone: 806-274-1342
  • Fax:
Mailing address:
  • Phone: 806-274-1342
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: KELI THOMPSON
Title or Position: OWNER
Credential: SLP
Phone: 806-274-1342