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General NPI Number Information
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NPI Number | 1316571003
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Entity Type | Individual
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Provider Name | SHAREE NICOLE CUPP SLP ASSISTANT
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Gender | Female
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Dates
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Enumeration Date | 03/03/2020
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Last Update Date | 03/03/2020
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Provider Practice Location Address
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Address Line | 6530 HAWKS CREEK CT STE 107
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City | FORT WORTH
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State | TX
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Zip | 76114-1164
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Country | US
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Telephone | 817-435-4631
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Fax |
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Provider Business Mailing Address
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Address Line | 4351 FM 1195
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City | MINERAL WELLS
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State | TX
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Zip | 76067-0731
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Country | US
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Telephone | 940-745-0286
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2355S0801X
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Taxonomy Name | Speech-Language Assistant
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License Number | 36165
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License Number State | TX
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