Healthcare Provider Details

I. General information

NPI: 1881160398
Provider Name (Legal Business Name): RYAN EMILY DELAHUNT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/23/2018
Last Update Date: 10/23/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2104 GREENBRIAR DR STE A
SOUTHLAKE TX
76092-8355
US

IV. Provider business mailing address

2707 N FITZHUGH AVE APT 1254
DALLAS TX
75204-3263
US

V. Phone/Fax

Practice location:
  • Phone: 817-442-9022
  • Fax: 866-300-8627
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number115200
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: