Healthcare Provider Details

I. General information

NPI: 1639847536
Provider Name (Legal Business Name): PAULA LEANN LYTLE SPEECH PATHOLOGIST
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/03/2021
Last Update Date: 09/03/2021
Certification Date: 09/03/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

700 N CATHERINE ST
TERRELL TX
75160-2161
US

IV. Provider business mailing address

12189 WINDY LN
FORNEY TX
75126-7644
US

V. Phone/Fax

Practice location:
  • Phone: 972-563-7504
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number100887
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: