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General NPI Number Information
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NPI Number | 1215655154
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Entity Type | Individual
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Provider Name | PHILLIP CONWELL M.S., SLP-CCC
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Gender | Male
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Dates
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Enumeration Date | 08/17/2022
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Last Update Date | 08/17/2022
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Provider Practice Location Address
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Address Line | 3030 ROSEFIELD DR
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City | HOUSTON
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State | TX
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Zip | 77080-2610
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Country | US
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Telephone | 713-251-4142
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Fax |
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Provider Business Mailing Address
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Address Line | 22319 BRIDGESTONE PALM CT
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City | SPRING
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State | TX
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Zip | 77388-2891
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Country | US
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Telephone | 281-658-2285
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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 | 112797
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License Number State | TX
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