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General NPI Number Information
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NPI Number | 1235517400
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Entity Type | Organization
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Legal Business Name | GEORGIA M PHILLIPS CCC SLP LLC
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Dates
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Enumeration Date | 05/08/2015
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Last Update Date | 05/08/2015
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Provider Practice Location Address
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Address Line | 2600 OLD ALICE RD STE D
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City | BROWNSVILLE
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State | TX
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Zip | 78521-1456
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Country | US
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Telephone | 956-982-8578
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Fax | 956-350-8999
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Provider Business Mailing Address
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Address Line | 401 TESORO AVE
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City | RANCHO VIEJO
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State | TX
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Zip | 78575-9539
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Country | US
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Telephone | 956-793-3252
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Fax | 956-350-8999
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Authorized Official
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Title or Position | SOLE OWNER
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Name | GEORGIA M PHILLIPS
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Credential | CCC SLP
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Telephone | 956-793-3252
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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 | 10313
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License Number State | TX
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