=====================================================
General NPI Number Information
=====================================================
NPI Number | 1801606488
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | 16:24 THERAPY
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/07/2025
-----------------------------------------------------
Last Update Date | 01/07/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 140 RANGER ST
-----------------------------------------------------
City | HEREFORD
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 79045-4112
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 806-344-5248
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 140 RANGER ST
-----------------------------------------------------
City | HEREFORD
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 79045-4112
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 806-344-5248
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | SPEECH LANGUAGE PATHOLOGIST
-----------------------------------------------------
Name | KAITLYN GRACE HACKER-KEELING
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 806-344-5248
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QH0700X
-----------------------------------------------------
Taxonomy Name | Hearing and Speech Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------