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General NPI Number Information
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NPI Number | 1447943204
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Entity Type | Organization
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Legal Business Name | DYSPHAGIA THERAPY PLUS CM, LLC
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Dates
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Enumeration Date | 05/30/2023
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Last Update Date | 10/06/2023
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Provider Practice Location Address
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Address Line | 5445 ALMEDA RD STE 450
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City | HOUSTON
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State | TX
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Zip | 77004-7403
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Country | US
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Telephone | 832-622-4929
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Fax | 713-673-5113
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Provider Business Mailing Address
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Address Line | 5445 ALMEDA RD STE 450
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City | HOUSTON
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State | TX
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Zip | 77004-7403
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Country | US
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Telephone | 832-622-4929
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Fax | 713-673-5113
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Authorized Official
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Title or Position | SPEECH-LANGUAGE PATHOLOGIST
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Name | GILDA LETRICA JACK-JOHNSON
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Credential | M ED CCC/SLP
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Telephone | 832-622-4929
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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 |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QH0700X
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Taxonomy Name | Hearing and Speech Clinic/Center
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License Number |
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License Number State |
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