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General NPI Number Information
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NPI Number | 1992079032
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Entity Type | Organization
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Legal Business Name | RICHARDSON
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Dates
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Enumeration Date | 03/07/2012
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Last Update Date | 03/07/2012
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Provider Practice Location Address
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Address Line | 4350 SIGMA RD STE 100
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City | DALLAS
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State | TX
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Zip | 75244-4421
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Country | US
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Telephone | 214-397-5230
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Fax |
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Provider Business Mailing Address
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Address Line | 1701 N COLLINS BLVD STE 100
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City | RICHARDSON
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State | TX
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Zip | 75080-3668
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | INSURANCE BILLING MANAGER
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Name | ANN BRACELAND
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Credential |
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Telephone | 469-385-7292
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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 | 107534
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License Number State | TX
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