MEDICARE: MILLICENT MCBRIDE

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	110566	TX

General Provider Information

NPI Number	:	1225511207
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MILLICENT MCBRIDE

Provider Business Mailing Address
First Line	:	7907 DON DAVID DR
Second Line	:
City	:	SHREVEPORT
State	:	LA
Zip	:	71129-4652
Country	:	US
Telephone Number	:	318-347-0726
Fax Number	:

Provider Business Practice Location Address
First Line	:	6011 MORNINGSIDE AVE
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75206-5923
Country	:	US
Telephone Number	:	318-347-0726
Fax Number	:

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

Provider Enumeration Date	:	09/14/2018
Last Update Date	:	09/14/2018

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Directions to “ MILLICENT MCBRIDE ” Practice Location

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