=====================================================
General NPI Number Information
=====================================================
NPI Number | 1316246432
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SPEECH MASTERS, INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/16/2011
-----------------------------------------------------
Last Update Date | 03/16/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 10333 HARWIN DR SUITE 388
-----------------------------------------------------
City | HOUSTON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77036-1545
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 832-656-7775
-----------------------------------------------------
Fax | 832-550-2400
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5943 SAGAMORE BAY LN
-----------------------------------------------------
City | RICHMOND
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77469-7203
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 832-656-7775
-----------------------------------------------------
Fax | 832-550-2400
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | SPEECH/LANGUAGE PATHOLOGIST
-----------------------------------------------------
Name | MR. CLAUDE NATHANIEL JACKSON IV
-----------------------------------------------------
Credential | M.ED., CCC-SLP
-----------------------------------------------------
Telephone | 832-656-7775
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 235Z00000X
-----------------------------------------------------
Taxonomy Name | Speech-Language Pathologist
-----------------------------------------------------
License Number | 18700
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------