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General NPI Number Information
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NPI Number | 1114644580
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Entity Type | Organization
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Legal Business Name | FLOURISH SPEECH THERAPY
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Dates
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Enumeration Date | 10/25/2022
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Last Update Date | 10/25/2022
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Provider Practice Location Address
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Address Line | 3401 GREENBRIAR STE 100
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City | MIDLAND
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State | TX
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Zip | 79707-4653
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Country | US
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Telephone | 432-363-5422
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Fax | 432-216-5329
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Provider Business Mailing Address
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Address Line | 3501 CRESTMONT DR
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City | MIDLAND
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State | TX
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Zip | 79707-4203
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Country | US
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Telephone | 806-543-1677
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Fax | 432-216-5329
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Authorized Official
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Title or Position | SPEECH PATHOLOGIST
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Name | REBECCA FONSECA
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Credential |
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Telephone | 806-543-1677
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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 |
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License Number State |
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