MEDICARE: SPEECH SUCCESS, 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	225X00000X	Occupational Therapist
2	235Z00000X	Speech-Language Pathologist	19324	TX

General Provider Information

NPI Number	:	1568660892
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SPEECH SUCCESS, LLC

Provider Business Mailing Address
First Line	:	1701 DOVE AVE STE D
Second Line	:
City	:	MCALLEN
State	:	TX
Zip	:	78504-3955
Country	:	US
Telephone Number	:	956-664-9395
Fax Number	:	956-661-9495

Provider Business Practice Location Address
First Line	:	1701 DOVE AVE STE D
Second Line	:
City	:	MCALLEN
State	:	TX
Zip	:	78504-3955
Country	:	US
Telephone Number	:	956-664-9395
Fax Number	:	956-661-9495

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	MRS. FAVIOLA H TREVINO
Credential	:	M.A., CCC-SLP
Telephone Number	:	956-664-9395

Provider Enumeration Date	:	07/09/2007
Last Update Date	:	07/12/2007

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Directions to “SPEECH SUCCESS, LLC ” Practice Location

Language	Start Address	Practice Location

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