Healthcare Provider Details

I. General information

NPI: 1144881558
Provider Name (Legal Business Name): MELINDA KAYE LENTZ SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/26/2019
Last Update Date: 06/26/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4309 OLD JACKSBORO HWY, ST 101
WICHITA FALLS TX
76302
US

IV. Provider business mailing address

4309 OLD JACKSBORO HWY, ST 101
WICHITA FALLS TX
76302
US

V. Phone/Fax

Practice location:
  • Phone: 940-386-1004
  • Fax: 940-386-9944
Mailing address:
  • Phone: 940-386-1004
  • Fax: 940-386-9944

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number104392
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: