MEDICARE: FEEDING AND DYSPHAGIA RESOURCES PC

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

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0026QK	OTHER	TX	BCBS

General Provider Information

NPI Number	:	1700073079
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FEEDING AND DYSPHAGIA RESOURCES PC

Provider Business Mailing Address
First Line	:	PO BOX 2023
Second Line	:
City	:	DENTON
State	:	TX
Zip	:	76202-2023
Country	:	US
Telephone Number	:	940-384-6238
Fax Number	:

Provider Business Practice Location Address
First Line	:	1105 LIVE OAK DR
Second Line	:
City	:	PROVIDENCE VILLAGE
State	:	TX
Zip	:	76227-5491
Country	:	US
Telephone Number	:	214-538-7328
Fax Number	:

Authorized Official
Title or Position	:	COO
Name	:	SUSAN SOWDER
Credential	:	CPC, CCP
Telephone Number	:	940-384-6238

Provider Enumeration Date	:	10/01/2007
Last Update Date	:	07/10/2008

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Directions to “FEEDING AND DYSPHAGIA RESOURCES PC ” Practice Location

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