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General NPI Number Information
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NPI Number | 1073960548
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Entity Type | Organization
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Legal Business Name | MARY GARCIA, M.S., CCC-SLP, PLLC
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Dates
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Enumeration Date | 05/16/2016
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Last Update Date | 05/16/2016
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Provider Practice Location Address
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Address Line | 850 TOWER DR SUITE 112
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City | ODESSA
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State | TX
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Zip | 79761-4238
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Country | US
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Telephone | 432-214-1218
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Fax |
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Provider Business Mailing Address
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Address Line | 1722 E 11TH ST
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City | ODESSA
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State | TX
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Zip | 79761-2917
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Country | US
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Telephone | 432-214-1218
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Fax |
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Authorized Official
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Title or Position | SPEECH LANGUAGE PATHOLOGIST
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Name | MARY GARCIA
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Credential | M.S., CCC-SLP
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Telephone | 432-214-1218
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number | 104558
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License Number State | TX
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