=====================================================
General NPI Number Information
=====================================================
NPI Number | 1750526190
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SPEECH SERVICES OF HOUSTON, INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/15/2008
-----------------------------------------------------
Last Update Date | 12/15/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1001 MEDICAL PLAZA DR STE 140
-----------------------------------------------------
City | THE WOODLANDS
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77380-3209
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 281-367-2035
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1001 MEDICAL PLAZA DR STE 140
-----------------------------------------------------
City | THE WOODLANDS
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77380-3209
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DIRECTOR
-----------------------------------------------------
Name | POLLY GARDNER
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 281-367-2035
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 235Z00000X
-----------------------------------------------------
Taxonomy Name | Speech-Language Pathologist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------