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General NPI Number Information
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NPI Number | 1588041339
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Entity Type | Organization
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Legal Business Name | SPARKSPEECH TX, LLC
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Dates
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Enumeration Date | 04/30/2015
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Last Update Date | 04/30/2015
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Provider Practice Location Address
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Address Line | 1930 E ROSEMEADE PKWY SUITE 207
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City | CARROLLTON
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State | TX
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Zip | 75007-2473
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Country | US
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Telephone | 972-955-0068
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Fax | 972-695-8844
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Provider Business Mailing Address
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Address Line | 1930 E ROSEMEADE PKWY SUITE 207
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City | CARROLLTON
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State | TX
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Zip | 75007-2473
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Country | US
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Telephone | 972-955-0068
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Fax | 972-695-8844
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Authorized Official
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Title or Position | SPEECH LANGUAGE PATHOLOGIST
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Name | KRISTIN N MINSHALL
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Credential | M.S., CCC-SLP
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Telephone | 972-955-0068
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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 | 105188
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License Number State | TX
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