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General NPI Number Information
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NPI Number | 1902205826
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Entity Type | Organization
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Legal Business Name | SMALL TALK PEDIATRIC SPEECH THERAPY, LLC
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Dates
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Enumeration Date | 08/15/2014
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Last Update Date | 08/15/2014
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Provider Practice Location Address
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Address Line | 7500 STONEBROOK PKWY SUITE 102
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City | FRISCO
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State | TX
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Zip | 75034-5377
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Country | US
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Telephone | 214-429-3771
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Fax |
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Provider Business Mailing Address
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Address Line | 8312 WHITE STALLION TRL
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City | MCKINNEY
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State | TX
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Zip | 75070-6899
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Country | US
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Telephone | 214-429-3771
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Fax |
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Authorized Official
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Title or Position | SPEECH-LANGUAGE PATHOLOGIST
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Name | HOLLY UGLAND WILLIS
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Credential | M.S., CCC-SLP
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Telephone | 214-429-3771
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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 | 104843
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number | 19630
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License Number State | TX
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