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General NPI Number Information
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NPI Number | 1942625280
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Entity Type | Organization
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Legal Business Name | CHAMPAGNE THERAPY LLC
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Dates
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Enumeration Date | 02/24/2014
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Last Update Date | 02/24/2014
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Provider Practice Location Address
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Address Line | 3106 QUARRY PLACE LN
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City | KATY
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State | TX
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Zip | 77493-1796
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Country | US
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Telephone | 337-852-0971
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Fax |
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Provider Business Mailing Address
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Address Line | 3106 QUARRY PLACE LN
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City | KATY
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State | TX
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Zip | 77493-1796
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Country | US
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Telephone | 337-852-0971
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Fax |
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Authorized Official
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Title or Position | SPEECH LANGUAGE PATHOLOGIST/MANAGER
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Name | KIM CHAMPAGNE
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Credential | M.S., CCC-SLP
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Telephone | 337-344-5654
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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 | 801936574
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License Number State | TX
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