MEDICARE: DIVINE SPEECH THERAPY 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

General Provider Information

NPI Number	:	1093534323
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DIVINE SPEECH THERAPY SERVICES PLLC

Provider Business Mailing Address
First Line	:	5010 LAKE PARK DR
Second Line	:
City	:	MANSFIELD
State	:	TX
Zip	:	76063-6826
Country	:	US
Telephone Number	:	254-432-1221
Fax Number	:

Provider Business Practice Location Address
First Line	:	5010 LAKE PARK DR
Second Line	:
City	:	MANSFIELD
State	:	TX
Zip	:	76063-6826
Country	:	US
Telephone Number	:	254-432-1221
Fax Number	:

Authorized Official
Title or Position	:	CEO/OWNER
Name	:	LATIFAH ALEXANDER
Credential	:	CCC-SLP
Telephone Number	:	254-432-1221

Provider Enumeration Date	:	10/03/2024
Last Update Date	:	03/11/2026

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Directions to “DIVINE SPEECH THERAPY SERVICES PLLC ” Practice Location

Language	Start Address	Practice Location

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