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General NPI Number Information
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NPI Number | 1497171086
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Entity Type | Organization
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Legal Business Name | WACO SPEAKS LLC
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Dates
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Enumeration Date | 03/06/2014
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Last Update Date | 03/06/2014
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Provider Practice Location Address
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Address Line | 925 CHEYENNE TRL
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City | HEWITT
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State | TX
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Zip | 76643-3288
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Country | US
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Telephone | 706-847-9287
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Fax |
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Provider Business Mailing Address
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Address Line | 925 CHEYENNE TRL
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City | HEWITT
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State | TX
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Zip | 76643-3288
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | SPEECH PATHOLOGIST
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Name | MRS. KELLI H IRWIN
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Credential | SLP
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Telephone | 706-847-9287
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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 | 105491
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License Number State | TX
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