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General NPI Number Information
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NPI Number | 1780835983
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Entity Type | Individual
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Provider Name | JOHNETTE DYAN SEGURA CCC-SLP
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Gender | Female
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Dates
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Enumeration Date | 10/07/2008
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Last Update Date | 10/07/2008
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Provider Practice Location Address
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Address Line | 4225 LAKE ARTHUR DR
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City | PORT ARTHUR
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State | TX
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Zip | 77642-6490
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Country | US
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Telephone | 409-727-3193
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Fax |
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Provider Business Mailing Address
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Address Line | 9254 BAYOU DIN DR
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City | BEAUMONT
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State | TX
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Zip | 77705-7605
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Country | US
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Telephone | 409-794-3045
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | 24625
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License Number State | TX
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