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General NPI Number Information
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NPI Number | 1902649437
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Entity Type | Organization
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Legal Business Name | DERELIQUE HOLDINGS
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Dates
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Enumeration Date | 06/13/2024
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Last Update Date | 06/13/2024
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Provider Practice Location Address
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Address Line | 10306 PENSIVE DR
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City | DALLAS
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State | TX
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Zip | 75229-5826
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Country | US
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Telephone | 469-755-8864
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Fax |
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Provider Business Mailing Address
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Address Line | 10306 PENSIVE DR
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City | DALLAS
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State | TX
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Zip | 75229-5826
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Country | US
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Telephone | 469-755-8864
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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 | KIMBERLY SCHUSTER
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Credential | M.S
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Telephone | 469-755-8864
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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 |
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License Number State |
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