=====================================================
General NPI Number Information
=====================================================
NPI Number | 1437977055
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SINCERELY SPEECH, PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/02/2024
-----------------------------------------------------
Last Update Date | 11/16/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4646 MCKINNEY AVE APT 615
-----------------------------------------------------
City | DALLAS
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75205-4316
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 512-771-4853
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4646 MCKINNEY AVE APT 615
-----------------------------------------------------
City | DALLAS
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75205-4316
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 512-771-4853
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER, SPEECH-LANGUAGE PATHOLOGIST
-----------------------------------------------------
Name | ANNA GOODE
-----------------------------------------------------
Credential | M.S., CCC-SLP
-----------------------------------------------------
Telephone | 512-771-4853
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 235Z00000X
-----------------------------------------------------
Taxonomy Name | Speech-Language Pathologist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------