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General NPI Number Information
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NPI Number | 1497021117
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Entity Type | Organization
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Legal Business Name | COMKEY THERAPY
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Dates
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Enumeration Date | 03/27/2012
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Last Update Date | 03/27/2012
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Provider Practice Location Address
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Address Line | 3200 BROADWAY BLVD SUITE 250
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City | GARLAND
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State | TX
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Zip | 75043-1573
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Country | US
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Telephone | 972-271-6000
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Fax | 888-755-0789
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Provider Business Mailing Address
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Address Line | 3200 BROADWAY BLVD SUITE 250
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City | GARLAND
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State | TX
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Zip | 75043-1573
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Country | US
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Telephone | 972-271-6000
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Fax | 888-755-0789
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Authorized Official
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Title or Position | OWNER
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Name | CARLA CLARK
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Credential | MS CCC-SLP
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Telephone | 972-271-6000
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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 | 106104
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License Number State | TX
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