MEDICARE: IDENTIFY ASSESS AND TREAT SPEECH AND LANGUAGE SERVICES

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	105347	TX

General Provider Information

NPI Number	:	1295172393
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	IDENTIFY ASSESS AND TREAT SPEECH AND LANGUAGE SERVICES

Provider Business Mailing Address
First Line	:	13930 SUTTON GLEN LN
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77047-7544
Country	:	US
Telephone Number	:	713-283-1753
Fax Number	:

Provider Business Practice Location Address
First Line	:	13930 SUTTON GLEN LN
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77047-7544
Country	:	US
Telephone Number	:	713-283-1753
Fax Number	:

Authorized Official
Title or Position	:	SPEECH LANGUAGE PATHOLOGIST
Name	:	KASHONDA BOWIE-CLOPHUS
Credential	:	CCC-SLP
Telephone Number	:	713-870-9626

Provider Enumeration Date	:	05/29/2013
Last Update Date	:	05/29/2013

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Directions to “IDENTIFY ASSESS AND TREAT SPEECH AND LANGUAGE SERVICES ” Practice Location

Language	Start Address	Practice Location

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