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General NPI Number Information
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NPI Number | 1225328297
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Entity Type | Organization
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Legal Business Name | KIDS THERAPY BY DESIGN
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Dates
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Enumeration Date | 04/12/2011
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Last Update Date | 04/12/2011
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Provider Practice Location Address
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Address Line | 12922 AMBROSE DR
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City | FRISCO
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State | TX
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Zip | 75035-2360
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Country | US
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Telephone | 214-793-8545
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Fax |
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Provider Business Mailing Address
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Address Line | 12922 AMBROSE DR
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City | FRISCO
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State | TX
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Zip | 75035-2360
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Country | US
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Telephone | 214-793-8545
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Fax |
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Authorized Official
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Title or Position | SPEECH-LANGUAGE PATHOLOGIST
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Name | AMANDA CARTER
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Credential | M.S. CCC-SLP
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Telephone | 214-793-8545
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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 | 105288
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License Number State | TX
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