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General NPI Number Information
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NPI Number | 1245661594
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Entity Type | Organization
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Legal Business Name | REIMAGINE SPEECH AND LANGUAGE THERAPY, PLLC
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Dates
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Enumeration Date | 12/11/2013
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Last Update Date | 02/06/2014
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Provider Practice Location Address
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Address Line | 3896 FM 546
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City | PRINCETON
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State | TX
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Zip | 75407-4101
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Country | US
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Telephone | 214-994-7920
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 1743
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City | MCKINNEY
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State | TX
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Zip | 75070-8158
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Country | US
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Telephone | 214-994-7920
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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 | MRS. CHELSEA ROBERTS
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Credential | MS. CCC-SLP
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Telephone | 916-899-0822
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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 | 108692
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License Number State | TX
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