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General NPI Number Information
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NPI Number | 1508157306
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Entity Type | Organization
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Legal Business Name | CONQUEST SPEECH THERAPY SERVICES PLLC
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Dates
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Enumeration Date | 04/27/2011
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Last Update Date | 04/27/2011
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Provider Practice Location Address
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Address Line | 1472 N HAMPTON RD STE 107
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City | DESOTO
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State | TX
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Zip | 75115-3001
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Country | US
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Telephone | 214-213-0054
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Fax |
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Provider Business Mailing Address
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Address Line | 1472 N HAMPTON RD STE 107
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City | DESOTO
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State | TX
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Zip | 75115-3001
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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 | KENDALL CAIN
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Credential | M.S. CCC-SLP
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Telephone | 214-213-0054
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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 | 101594
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License Number State | TX
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