MEDICARE: AVERY JAMES

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

General Provider Information

NPI Number	:	1659155406
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AVERY JAMES

Provider Business Mailing Address
First Line	:	400 E ROYAL LN STE 112
Second Line	:
City	:	IRVING
State	:	TX
Zip	:	75039-3511
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	400 E ROYAL LN STE 112
Second Line	:
City	:	IRVING
State	:	TX
Zip	:	75039-3511
Country	:	US
Telephone Number	:	972-490-9055
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/22/2023
Last Update Date	:	08/22/2023

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Directions to “ AVERY JAMES ” Practice Location

Language	Start Address	Practice Location

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