=====================================================
General NPI Number Information
=====================================================
NPI Number | 1023697653
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ALIGN SPEECH AND NEURO SOLUTIONS
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/02/2021
-----------------------------------------------------
Last Update Date | 04/02/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 12550 GUMPER CT
-----------------------------------------------------
City | FORT WORTH
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 76126-6317
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 817-791-9262
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 126322
-----------------------------------------------------
City | BENBROOK
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 76126-0322
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 817-791-9262
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | SPEECH LANGUAGE PATHOLOGIST, OWNER
-----------------------------------------------------
Name | SAVANNAH L MCGRAW
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 817-791-9262
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 235Z00000X
-----------------------------------------------------
Taxonomy Name | Speech-Language Pathologist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------