MEDICARE: TANGIBLE DIFFERENCE LEARNING CENTER, 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	235Z00000X	Speech-Language Pathologist

General Provider Information

NPI Number	:	1225305287
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TANGIBLE DIFFERENCE LEARNING CENTER, LLC

Provider Business Mailing Address
First Line	:	7010 NW 100 DR
Second Line	:	#A104
City	:	HOUSTON
State	:	TX
Zip	:	77092-2052
Country	:	US
Telephone Number	:	713-462-6060
Fax Number	:	713-462-6066

Provider Business Practice Location Address
First Line	:	7010 NW 100 DR
Second Line	:	#A104
City	:	HOUSTON
State	:	TX
Zip	:	77092-2052
Country	:	US
Telephone Number	:	713-462-6060
Fax Number	:	713-462-6066

Authorized Official
Title or Position	:	SPEECH LANGUAGE PATHOLOGIST
Name	:	KELI ROD NEAL
Credential	:	SLP
Telephone Number	:	409-781-5855

Provider Enumeration Date	:	11/18/2011
Last Update Date	:	11/18/2011

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