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General NPI Number Information
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NPI Number | 1316803562
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Entity Type | Individual
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Provider Name | JACOB CHILDS
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Gender | Male
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Dates
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Enumeration Date | 12/31/2025
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Last Update Date | 12/31/2025
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Provider Practice Location Address
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Address Line | 215 E PLAZA BLVD
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City | HURST
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State | TX
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Zip | 76053-5151
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Country | US
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Telephone | 817-282-6777
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Fax |
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Provider Business Mailing Address
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Address Line | 1106 RIDGEWOOD TER
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City | ARLINGTON
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State | TX
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Zip | 76012-2415
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Country | US
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Telephone | 512-591-5490
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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 | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number | 118617
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License Number State | TX
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