MEDICARE: SPEECH 4 FUN THERAPEUTIC SERVICES, PLLC

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	100919	TX

General Provider Information

NPI Number	:	1073054193
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SPEECH 4 FUN THERAPEUTIC SERVICES, PLLC

Provider Business Mailing Address
First Line	:	5109 MALVERN DR
Second Line	:
City	:	PLANO
State	:	TX
Zip	:	75093-4935
Country	:	US
Telephone Number	:	214-274-9400
Fax Number	:	214-380-9409

Provider Business Practice Location Address
First Line	:	8105 RASOR BLVD
Second Line	:	SUITE 102
City	:	PLANO
State	:	TX
Zip	:	75024-0116
Country	:	US
Telephone Number	:	214-274-9400
Fax Number	:	214-380-9409

Authorized Official
Title or Position	:	OWNER
Name	:	MRS. KARA BETH PFISTER
Credential	:	M.S. CCC/SLP, COM
Telephone Number	:	214-274-9400

Provider Enumeration Date	:	03/09/2017
Last Update Date	:	03/09/2017

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