MEDICARE: LEGACY SPEECH GROUP 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	261QH0700X	Hearing and Speech Clinic/Center

General Provider Information

NPI Number	:	1386593929
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LEGACY SPEECH GROUP PLLC

Provider Business Mailing Address
First Line	:	6301 GASTON AVE, WEST TOWER, BOX 1508
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75214
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	6301 GASTON AVE, WEST TOWER,
Second Line	:	BOX1508
City	:	DALLAS
State	:	TX
Zip	:	75214
Country	:	US
Telephone Number	:	318-642-5628
Fax Number	:

Authorized Official
Title or Position	:	SPEECH-LANGUAGE PATHOLOGIST
Name	:	CURTESIA DAVIS
Credential	:	M.S.,CCC-SLP/L
Telephone Number	:	318-642-5628

Provider Enumeration Date	:	01/27/2026
Last Update Date	:	01/27/2026

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