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General NPI Number Information
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NPI Number | 1215708797
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Entity Type | Organization
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Legal Business Name | TINY BUT MIGHTY NICU TRANSITION PROGRAM, PLLC
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Dates
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Enumeration Date | 01/12/2024
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Last Update Date | 01/12/2024
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Provider Practice Location Address
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Address Line | 1112 SEMINOLE DR
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City | RICHARDSON
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State | TX
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Zip | 75080-3931
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Country | US
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Telephone | 214-937-5350
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Fax | 469-838-6488
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Provider Business Mailing Address
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Address Line | 1112 SEMINOLE DR
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City | RICHARDSON
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State | TX
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Zip | 75080-3931
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Country | US
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Telephone | 214-937-5350
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Fax | 469-838-6488
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Authorized Official
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Title or Position | SPEECH PATHOLOGIST, OWNER
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Name | GINA PISKE
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Credential | MS-CCC/SLP
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Telephone | 214-937-5350
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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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