=====================================================
General NPI Number Information
=====================================================
NPI Number | 1770559973
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | UNIVERSITY OF TEXAS AT DALLAS
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/27/2006
-----------------------------------------------------
Last Update Date | 02/27/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1966 INWOOD RD
-----------------------------------------------------
City | DALLAS
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75235-7205
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 972-883-3000
-----------------------------------------------------
Fax | 972-883-3016
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1966 INWOOD RD
-----------------------------------------------------
City | DALLAS
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75235-7205
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 972-883-3010
-----------------------------------------------------
Fax | 972-883-3022
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | ADMINISTRATIVE SERVICES OFFICER I
-----------------------------------------------------
Name | MS. ELIZABETH ELIZONDO
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 972-883-3010
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 235Z00000X
-----------------------------------------------------
Taxonomy Name | Speech-Language Pathologist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 237600000X
-----------------------------------------------------
Taxonomy Name | Audiologist-Hearing Aid Fitter
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 231H00000X
-----------------------------------------------------
Taxonomy Name | Audiologist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------