1558637330 NPI number — LOGOPEDIA THERAPY CLINIC, INC

Table of content: (NPI 1558637330)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1558637330 NPI number — LOGOPEDIA THERAPY CLINIC, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LOGOPEDIA THERAPY CLINIC, INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1558637330
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/27/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3409 W STATE HIGHWAY 107
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
EDINBURG
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
78539-2802
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
956-255-4154
Provider Business Mailing Address Fax Number:
956-255-4157

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
848 MANZANILLA COURT
Provider Second Line Business Practice Location Address:
SUITE 1
Provider Business Practice Location Address City Name:
ELSA
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78543-2798
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
956-255-4154
Provider Business Practice Location Address Fax Number:
956-255-4157
Provider Enumeration Date:
03/27/2012

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
GUTIERREZ
Authorized Official First Name:
DALIA
Authorized Official Middle Name:
IRENE
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
956-255-4154

Provider Taxonomy Codes

  • Taxonomy code: 2251P0200X , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 225XP0200X , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 235Z00000X , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)