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General NPI Number Information
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NPI Number | 1720921851
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Entity Type | Organization
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Legal Business Name | TRISERVE INTEGRATED SERVICES LLC
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Dates
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Enumeration Date | 04/13/2026
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Last Update Date | 04/13/2026
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Provider Practice Location Address
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Address Line | 607 CARDWELL DR
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City | LANCASTER
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State | TX
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Zip | 75146-2176
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Country | US
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Telephone | 214-455-6163
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Fax |
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Provider Business Mailing Address
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Address Line | 607 CARDWELL DR
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City | LANCASTER
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State | TX
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Zip | 75146-2176
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | CL JOHNSON
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Credential |
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Telephone | 214-455-6163
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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 |
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License Number State |
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