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General NPI Number Information
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NPI Number | 1942840459
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Entity Type | Organization
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Legal Business Name | FORT WORTH SPEECH THERAPY LLC
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Dates
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Enumeration Date | 01/13/2020
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Last Update Date | 01/13/2020
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Provider Practice Location Address
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Address Line | 6913 CAMP BOWIE BLVD
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City | FORT WORTH
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State | TX
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Zip | 76116-7163
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Country | US
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Telephone | 817-995-4233
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Fax |
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Provider Business Mailing Address
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Address Line | 5613 COVEY LN
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City | WICHITA FALLS
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State | TX
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Zip | 76310-1788
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Country | US
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Telephone | 817-995-4233
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Fax |
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Authorized Official
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Title or Position | OWNER/SLP
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Name | ROBERT WINCOWSKI
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Credential | SLP
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Telephone | 817-995-4233
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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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