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General NPI Number Information
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NPI Number | 1609558063
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Entity Type | Individual
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Provider Name | ALLY ANTLE M.S. CCC-SLP
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Gender | Female
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Dates
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Enumeration Date | 08/04/2023
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Last Update Date | 08/04/2023
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Provider Practice Location Address
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Address Line | 31141 NICHOLS SAWMILL RD
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City | MAGNOLIA
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State | TX
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Zip | 77355-6032
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Country | US
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Telephone | 713-822-5980
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Fax |
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Provider Business Mailing Address
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Address Line | 25715 SIMBRAH DR
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City | MAGNOLIA
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State | TX
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Zip | 77355-4385
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Country | US
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Telephone | 530-776-4903
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | 119758
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License Number State | TX
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