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General NPI Number Information
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NPI Number | 1265969547
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Entity Type | Organization
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Legal Business Name | SMALL TALK SPEECH AND LANGUAGE THERAPY PLLC
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Dates
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Enumeration Date | 05/17/2017
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 15312 HYSON XING
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City | PFLUGERVILLE
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State | TX
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Zip | 78660-3046
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Country | US
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Telephone | 512-585-6888
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Fax |
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Provider Business Mailing Address
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Address Line | 15312 HYSON XING
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City | PFLUGERVILLE
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State | TX
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Zip | 78660-3046
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Country | US
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Telephone | 512-585-6888
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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 | JULIE MICHELLE JOHANSON
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Credential |
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Telephone | 512-585-6888
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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 | 102119
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License Number State | TX
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