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NPI Code Detail

MEDICARE: MR. MICHAEL GLEN PEARSON CCC-SLP

MEDICARE: MR. MICHAEL GLEN PEARSON 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 Pathologist18138TX

General Provider Information

NPI Number : 1861520066
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. MICHAEL GLEN PEARSON CCC-SLP
Provider Business Mailing Address
First Line : 6105 HAMMAN ST
Second Line :
City : HOUSTON
State : TX
Zip : 77007-2128
Country : US
Telephone Number : 713-522-8803
Fax Number :
Provider Business Practice Location Address
First Line : 8021 BISSONNET ST
Second Line :
City : HOUSTON
State : TX
Zip : 77074-5200
Country : US
Telephone Number : 713-774-5437
Fax Number : 713-774-5445
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/01/2007
Last Update Date : 07/09/2007

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