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General NPI Number Information
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NPI Number | 1417431461
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Entity Type | Organization
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Legal Business Name | GULF COAST SPEECH PATHOLOGY LLC
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Dates
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Enumeration Date | 09/17/2018
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Last Update Date | 09/17/2018
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Provider Practice Location Address
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Address Line | 928 BROADWAY ST
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City | GALVESTON
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State | TX
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Zip | 77550-6228
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Country | US
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Telephone | 409-242-6500
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Fax | 409-497-4389
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Provider Business Mailing Address
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Address Line | PO BOX 57
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City | GALVESTON
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State | TX
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Zip | 77553-0057
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Country | US
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Telephone | 409-242-6500
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Fax | 409-497-4389
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | JULIE MARY BONOMO
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Credential |
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Telephone | 409-242-6500
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR0400X
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Taxonomy Name | Rehabilitation Clinic/Center
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License Number |
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License Number State |
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