1053753483 NPI number — LET'S TALK SPEECH THERAPY

Table of content: (NPI 1053753483)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1053753483 NPI number — LET'S TALK SPEECH THERAPY

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LET'S TALK SPEECH THERAPY
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:
1053753483
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/26/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5470 W LOVERS LN
Provider Second Line Business Mailing Address:
SUITE 333A
Provider Business Mailing Address City Name:
DALLAS
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75209-4264
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
214-242-9654
Provider Business Mailing Address Fax Number:
480-247-4581

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5470 W LOVERS LN
Provider Second Line Business Practice Location Address:
SUITE 333A
Provider Business Practice Location Address City Name:
DALLAS
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
75209-4264
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
214-242-9654
Provider Business Practice Location Address Fax Number:
480-247-4581
Provider Enumeration Date:
07/26/2013

Additional Information

Authorized Official

Authorized Official Last Name:
SOROKWASZ
Authorized Official First Name:
MEREDITH
Authorized Official Middle Name:
B
Authorized Official Title or Position:
SPEECH-LANGUAGE PATHOLOGIST / OWNER
Authorized Official Telephone Number:
214-242-9654

Provider Taxonomy Codes

  • Taxonomy code: 235Z00000X , with the licence number:  100745 , 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)





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