MEDICARE: NORTH DALLAS SPEECH, 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	225XP0200X	Pediatric Occupational Therapist
2	2251P0200X	Pediatric Physical Therapist
3	235Z00000X	Speech-Language Pathologist	101280	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0062NF	OTHER	TX	BCBS OF TX GROUP #
2	87547T	OTHER	TX	BCBS OF TX ROBIN COLLINS

General Provider Information

NPI Number	:	1962551309
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NORTH DALLAS SPEECH, LLC

Provider Business Mailing Address
First Line	:	4248 MILLVIEW LN
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75287-3964
Country	:	US
Telephone Number	:	214-505-6787
Fax Number	:

Provider Business Practice Location Address
First Line	:	4480 BELTWAY DR
Second Line	:
City	:	ADDISON
State	:	TX
Zip	:	75001-3705
Country	:	US
Telephone Number	:	214-505-6787
Fax Number	:	972-385-0405

Authorized Official
Title or Position	:	ADMINISTRATOR, LEAD SLP
Name	:	MRS. ROBIN ANNETTE COLLINS
Credential	:	M.S., CCC-SLP
Telephone Number	:	214-505-6787

Provider Enumeration Date	:	01/08/2007
Last Update Date	:	11/15/2007

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