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General NPI Number Information
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NPI Number | 1689390718
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Entity Type | Organization
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Legal Business Name | OUTGROW THERAPEUTICS
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Dates
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Enumeration Date | 10/19/2022
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Last Update Date | 10/19/2022
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Provider Practice Location Address
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Address Line | 721 DOROTHY ST
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City | HOUSTON
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State | TX
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Zip | 77007-1742
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Country | US
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Telephone | 845-548-4043
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Fax |
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Provider Business Mailing Address
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Address Line | 721 DOROTHY ST
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City | HOUSTON
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State | TX
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Zip | 77007-1742
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Country | US
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Telephone | 845-548-4043
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Fax |
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Authorized Official
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Title or Position | OWNER, SPEECH-PATHOLOGIST, BCBA
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Name | MS. MARTIE F KROL
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Credential | M.S., CCC, SLP, BCBA
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Telephone | 845-548-4043
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number |
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License Number State |
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