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General NPI Number Information
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NPI Number | 1083957898
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Entity Type | Organization
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Legal Business Name | BANDERA SPEECH THERAPY LLC
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Dates
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Enumeration Date | 03/29/2013
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Last Update Date | 03/29/2013
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Provider Practice Location Address
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Address Line | 157 HWY 16 SOUTH
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City | BANDERA
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State | TX
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Zip | 78003
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Country | US
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Telephone | 888-958-3579
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Fax | 888-958-3579
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Provider Business Mailing Address
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Address Line | 903 FLYING L DR
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City | BANDERA
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State | TX
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Zip | 78003-4289
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Country | US
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Telephone | 888-958-3579
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Fax | 888-958-3579
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Authorized Official
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Title or Position | PRESIDENT/OWNER
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Name | APRIL SMITH
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Credential | MA MED CCC
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Telephone | 888-958-3579
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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 | 105775
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License Number State | TX
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