1568916997 NPI number — TERRI LEAANN WRIGHT SLP

Table of content: TERRI LEAANN WRIGHT SLP (NPI 1568916997)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1568916997 NPI number — TERRI LEAANN WRIGHT SLP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WRIGHT
Provider First Name:
TERRI
Provider Middle Name:
LEAANN
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
SLP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
TAYLOR
Provider Other First Name:
TERRI
Provider Other Middle Name:
LEAANN
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1568916997
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/15/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1201 S IH 35
Provider Second Line Business Mailing Address:
STE.105
Provider Business Mailing Address City Name:
ROUND ROCK
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
78664-6615
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
512-310-7665
Provider Business Mailing Address Fax Number:
512-310-9228

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1201 S IH 35
Provider Second Line Business Practice Location Address:
STE.105
Provider Business Practice Location Address City Name:
ROUND ROCK
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78664-6615
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
512-310-7665
Provider Business Practice Location Address Fax Number:
512-310-9228
Provider Enumeration Date:
08/15/2016

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 235Z00000X , with the licence number:  111600 , 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)

  • Identifier: 094474602 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".