MEDICARE: IPPOLITO SPEECH-LANGUAGE THERAPY SERVICES, P.L.L.C.

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	261QH0700X	Hearing and Speech Clinic/Center

General Provider Information

NPI Number	:	1275179855
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	IPPOLITO SPEECH-LANGUAGE THERAPY SERVICES, P.L.L.C.

Provider Business Mailing Address
First Line	:	1200 MAIN ST APT 1001
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75202-4303
Country	:	US
Telephone Number	:	469-442-5105
Fax Number	:

Provider Business Practice Location Address
First Line	:	1200 MAIN ST APT 1001
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75202-4303
Country	:	US
Telephone Number	:	469-442-5105
Fax Number	:

Authorized Official
Title or Position	:	SPEECH-LANGUAGE PATHOLOGIST
Name	:	MARTA IPPOLITO
Credential	:	M.S., CCC-SLP
Telephone Number	:	469-442-5105

Provider Enumeration Date	:	11/19/2019
Last Update Date	:	11/19/2019

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