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General NPI Number Information
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NPI Number | 1407889694
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Entity Type | Organization
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Legal Business Name | LOGOPEDIA THERAPY CLINIC, INC.
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Dates
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Enumeration Date | 07/09/2006
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Last Update Date | 10/15/2009
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Provider Practice Location Address
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Address Line | 3409 W STATE HIGHWAY 107
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City | EDINBURG
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State | TX
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Zip | 78539-2802
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Country | US
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Telephone | 956-380-3400
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Fax | 956-380-3448
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Provider Business Mailing Address
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Address Line | 3409 W STATE HIGHWAY 107
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City | EDINBURG
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State | TX
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Zip | 78539-2802
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Country | US
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Telephone | 956-380-3400
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Fax | 956-380-3448
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Authorized Official
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Title or Position | OWNER / MANAGER
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Name | MRS. DALIA I. GUTIERREZ
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Credential | MS,CCC,SLP
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Telephone | 956-380-3400
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225XP0200X
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Taxonomy Name | Pediatric Occupational Therapist
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License Number | 111342
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number | 102044
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License Number State | TX
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Taxonomy #3
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Taxonomy Code | 2251P0200X
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Taxonomy Name | Pediatric Physical Therapist
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License Number | 1060036
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License Number State | TX
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