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General NPI Number Information
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NPI Number | 1336309327
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Entity Type | Organization
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Legal Business Name | PERMIAN BASIN SPEECH LANGUAGE AND LEARNING SERVICES INC
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Dates
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Enumeration Date | 06/12/2008
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Last Update Date | 06/12/2008
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Provider Practice Location Address
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Address Line | 3300 N A ST BUILDING 7-260
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City | MIDLAND
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State | TX
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Zip | 79705-5421
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Country | US
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Telephone | 432-570-4400
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Fax | 432-570-4460
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Provider Business Mailing Address
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Address Line | 3300 N A ST BUILDING 7-260
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City | MIDLAND
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State | TX
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Zip | 79705-5421
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Country | US
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Telephone | 432-570-4400
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Fax | 432-570-4460
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Authorized Official
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Title or Position | SPEECH PATHOLOGIST
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Name | LISA IRVIN
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Credential | M.S.
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Telephone | 432-570-4400
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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 | 14147
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License Number State | TX
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