Healthcare Provider Details

I. General information

NPI: 1215370820
Provider Name (Legal Business Name): BARBARA JEAN WYLIE M.ED SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/12/2013
Last Update Date: 04/12/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16835 DEER CREEK DR
SPRING TX
77379-4968
US

IV. Provider business mailing address

16835 DEER CREEK DR.
SPRING TX
77379
US

V. Phone/Fax

Practice location:
  • Phone: 281-379-4373
  • Fax:
Mailing address:
  • Phone: 281-379-4373
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number11963
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: