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General NPI Number Information
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NPI Number | 1407390719
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Entity Type | Individual
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Provider Name | DR. MALESA REESE
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Gender | Female
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Dates
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Enumeration Date | 12/06/2016
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Last Update Date | 12/06/2016
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Provider Practice Location Address
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Address Line | 912 S ERVAY ST
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City | DALLAS
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State | TX
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Zip | 75201-6420
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Country | US
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Telephone | 972-581-4100
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Fax |
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Provider Business Mailing Address
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Address Line | 12225 GREENVILLE AVE STE 600
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City | DALLAS
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State | TX
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Zip | 75243-9362
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Country | US
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Telephone | 940-300-5242
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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 | 110175
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License Number State | TX
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