=====================================================
General NPI Number Information
=====================================================
NPI Number | 1134903164
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SPRING SPEECH THERAPY, PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/21/2023
-----------------------------------------------------
Last Update Date | 09/27/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 8900 EASTLOCH DRIVE BUILDING 135, SUITE O
-----------------------------------------------------
City | SPRING
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77379-2337
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 346-347-3775
-----------------------------------------------------
Fax | 346-347-3875
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 20212 CHAMPION FOREST DR SUITE 700, UNIT 376
-----------------------------------------------------
City | SPRING
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77379-8783
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 346-347-3775
-----------------------------------------------------
Fax | 346-347-3875
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | SPEECH LANGUAGE PATHOLOGIST
-----------------------------------------------------
Name | MYRNA E MOLINARO
-----------------------------------------------------
Credential | M.A., CCC-SLP
-----------------------------------------------------
Telephone | 346-347-3775
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 235Z00000X
-----------------------------------------------------
Taxonomy Name | Speech-Language Pathologist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------