MEDICARE: PREMIER SPEECH & SWALLOWING SOLUTIONS LLC

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	103K00000X	Behavior Analyst
2	235Z00000X	Speech-Language Pathologist	101079	TX
3	235Z00000X	Speech-Language Pathologist

General Provider Information

NPI Number	:	1073939237
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PREMIER SPEECH & SWALLOWING SOLUTIONS LLC

Provider Business Mailing Address
First Line	:	18502 GREEN LAND WAY STE D
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77084-7967
Country	:	US
Telephone Number	:	281-717-4308
Fax Number	:	877-886-0898

Provider Business Practice Location Address
First Line	:	18502 GREEN LAND WAY STE D
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77084-7967
Country	:	US
Telephone Number	:	281-717-4308
Fax Number	:	877-886-0898

Authorized Official
Title or Position	:	OWNER
Name	:	VONETTA CLARK-ALLEN
Credential	:	CCC-SLP
Telephone Number	:	281-717-4308

Provider Enumeration Date	:	03/12/2014
Last Update Date	:	09/28/2022

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Language	Start Address	Practice Location

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