Healthcare Provider Details

I. General information

NPI: 1083307516
Provider Name (Legal Business Name): BUBBLE SPEECH THERAPY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/31/2023
Last Update Date: 05/31/2023
Certification Date: 05/31/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

110 MAIN ST
SULPHUR SPRINGS TX
75482-2705
US

IV. Provider business mailing address

PO BOX 234
SULPHUR SPRINGS TX
75483-0234
US

V. Phone/Fax

Practice location:
  • Phone: 903-243-0702
  • Fax: 888-388-0782
Mailing address:
  • Phone: 903-243-0702
  • Fax: 888-388-0782

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: KACIE CROWSON
Title or Position: OWNER
Credential: SLP
Phone: 903-243-0702