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General NPI Number Information
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NPI Number | 1053799452
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Entity Type | Organization
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Legal Business Name | SPEECH WINGS, LLC
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Dates
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Enumeration Date | 05/18/2015
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Last Update Date | 05/18/2015
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Provider Practice Location Address
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Address Line | 3130 N SHILOH RD
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City | GARLAND
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State | TX
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Zip | 75044-8014
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Country | US
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Telephone | 214-864-3013
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 961
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City | WYLIE
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State | TX
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Zip | 75098-0961
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | CHIEF EXECUTIVE OFFICER
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Name | COURTNEY WILLIS
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Credential | M.S., CCC-SLP
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Telephone | 214-864-3013
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QH0700X
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Taxonomy Name | Hearing and Speech Clinic/Center
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License Number | 108758
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License Number State | TX
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