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General NPI Number Information
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NPI Number | 1174246185
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Entity Type | Individual
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Provider Name | LAURIE STATES SLP
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Gender | Female
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Dates
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Enumeration Date | 09/23/2022
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Last Update Date | 10/19/2022
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Provider Practice Location Address
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Address Line | 6211 E GRAND AVE
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City | DALLAS
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State | TX
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Zip | 75223-1425
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Country | US
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Telephone | 214-824-4747
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Fax |
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Provider Business Mailing Address
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Address Line | 10925 FERNALD AVE
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City | DALLAS
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State | TX
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Zip | 75218-1205
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Country | US
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Telephone | 214-808-4798
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | 19555
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License Number State | TX
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