=====================================================
General NPI Number Information
=====================================================
NPI Number | 1144091836
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | EINSTEIN SPEECH THERAPY LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/11/2024
-----------------------------------------------------
Last Update Date | 01/11/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1727 KELLER PKWY STE 19
-----------------------------------------------------
City | KELLER
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 76248-3705
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 817-500-5895
-----------------------------------------------------
Fax | 817-646-5745
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 7850 PARK FALLS CT
-----------------------------------------------------
City | FORT WORTH
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 76137-5486
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 707-799-9945
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER/SPEECH-LANGUAGE PATHOLOGIST
-----------------------------------------------------
Name | KATHERINE HINKLE
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 817-500-5895
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 235Z00000X
-----------------------------------------------------
Taxonomy Name | Speech-Language Pathologist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 261Q00000X
-----------------------------------------------------
Taxonomy Name | Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------