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General NPI Number Information
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NPI Number | 1720210156
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Entity Type | Organization
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Legal Business Name | FORT WORTH INDEPENDENT SCHOOL SYSTEM
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Dates
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Enumeration Date | 08/19/2009
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Last Update Date | 08/19/2009
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Provider Practice Location Address
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Address Line | 5100 EL CAMPO AVE SPEECH, LANGUAGE & HEARING SERVICES
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City | FORT WORTH
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State | TX
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Zip | 76107-4864
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Country | US
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Telephone | 817-814-6449
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Fax | 817-814-6452
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Provider Business Mailing Address
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Address Line | 5100 EL CAMPO AVE SPEECH, LANGUAGE & HEARING SERVICES
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City | FORT WORTH
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State | TX
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Zip | 76107-4864
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Country | US
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Telephone | 817-814-6449
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Fax | 817-814-6452
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Authorized Official
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Title or Position | AUDIOLOGIST
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Name | DR. KATHLEEN ANNE EVERSON
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Credential | AUD
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Telephone | 817-814-6449
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251300000X
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Taxonomy Name | Local Education Agency (LEA)
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License Number | 50623
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 251300000X
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Taxonomy Name | Local Education Agency (LEA)
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License Number | 50573
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License Number State | TX
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Taxonomy #3
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Taxonomy Code | 251300000X
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Taxonomy Name | Local Education Agency (LEA)
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License Number | 50124
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License Number State | TX
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