=====================================================
General NPI Number Information
=====================================================
NPI Number | 1639050396
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | RISE & SHINE SPEECH AND LANGUAGE, PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/09/2025
-----------------------------------------------------
Last Update Date | 09/09/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 330 TWIN OAK
-----------------------------------------------------
City | ADKINS
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78101-2311
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 210-201-6677
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 330 TWIN OAK
-----------------------------------------------------
City | ADKINS
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78101-2311
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 210-201-6677
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | SPEECH LANGUAGE PATHOLOGIST
-----------------------------------------------------
Name | KRISTA M DOTSON
-----------------------------------------------------
Credential | M.S. CCC-SLP
-----------------------------------------------------
Telephone | 210-393-7929
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 235Z00000X
-----------------------------------------------------
Taxonomy Name | Speech-Language Pathologist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------