=====================================================
General NPI Number Information
=====================================================
NPI Number | 1811650005
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | LILIAN SYOKAU MUTUA-MUETI M.S., CCC-SLP
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/15/2021
-----------------------------------------------------
Last Update Date | 10/15/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2011 BROADWAY ST STE 130
-----------------------------------------------------
City | PEARLAND
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77581-5945
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 832-594-8912
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2414 COUNTY ROAD 90 APT 1412
-----------------------------------------------------
City | PEARLAND
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77584-5127
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 832-594-8912
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 235Z00000X
-----------------------------------------------------
Taxonomy Name | Speech-Language Pathologist
-----------------------------------------------------
License Number | 116602
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------