MEDICARE: VICE VERSA SPEECH AND LANGUAGE SERVICES, PLLC

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	:	1992309421
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	VICE VERSA SPEECH AND LANGUAGE SERVICES, PLLC

Provider Business Mailing Address
First Line	:	6230 N BELT LINE RD STE 300
Second Line	:
City	:	IRVING
State	:	TX
Zip	:	75063-2657
Country	:	US
Telephone Number	:	469-320-1700
Fax Number	:	469-320-1732

Provider Business Practice Location Address
First Line	:	6230 N BELT LINE RD STE 300
Second Line	:
City	:	IRVING
State	:	TX
Zip	:	75063-2657
Country	:	US
Telephone Number	:	469-320-1700
Fax Number	:	469-320-1732

Authorized Official
Title or Position	:	OWNER/SLP
Name	:	DEBORAH MODE
Credential	:	MS, CCC-SLP
Telephone Number	:	469-320-1700

Provider Enumeration Date	:	11/25/2020
Last Update Date	:	01/25/2024

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Directions to “VICE VERSA SPEECH AND LANGUAGE SERVICES, PLLC ” Practice Location

Language	Start Address	Practice Location

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