MEDICARE: MS. MERCEDES GENELLE TOBEY

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	235Z00000X	Speech-Language Pathologist

General Provider Information

NPI Number	:	1053913624
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. MERCEDES GENELLE TOBEY

Provider Business Mailing Address
First Line	:	14651 DALLAS PKWY
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75254-7476
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4524 BOAT CLUB RD STE 180
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76135-7025
Country	:	US
Telephone Number	:	817-764-3825
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/09/2020
Last Update Date	:	02/29/2024

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