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NPI Code Detail

MEDICARE: TARON M WALLACE M.S., CCC-SLP

MEDICARE: TARON M WALLACE M.S., CCC-SLP
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
1235Z00000XSpeech-Language Pathologist108682TX

General Provider Information

NPI Number : 1588336788
Entity Type Code : Individual
Provider Name (Legal Business Name) : TARON M WALLACE M.S., CCC-SLP
Provider Business Mailing Address
First Line : 7500 OAKMONT BLVD
Second Line :
City : FORT WORTH
State : TX
Zip : 76132-4200
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 6251 STEVENSON OAKS DR
Second Line :
City : FT WORTH
State : TX
Zip : 76123-2783
Country : US
Telephone Number : 800-381-0822
Fax Number : 352-565-5201
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/05/2021
Last Update Date : 04/23/2025

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Directions to “ TARON M WALLACE M.S., CCC-SLP” Practice Location

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