1962597617 NPI number — THE SPEECH ENRICHMENT CENTER, LP

Table of content: (NPI 1962597617)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1962597617 NPI number — THE SPEECH ENRICHMENT CENTER, LP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
THE SPEECH ENRICHMENT CENTER, LP
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:
6
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:
1962597617
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/21/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6140 HIGHWAY 6 # 90
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MISSOURI CITY
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
77459-3802
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
281-403-5437
Provider Business Mailing Address Fax Number:
281-403-1002

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3424 FM 1092 RD
Provider Second Line Business Practice Location Address:
SUITE 200
Provider Business Practice Location Address City Name:
MISSOURI CITY
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
77459-2285
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
281-403-5437
Provider Business Practice Location Address Fax Number:
281-403-1002
Provider Enumeration Date:
10/04/2006

Additional Information

Authorized Official

Authorized Official Last Name:
WHITE
Authorized Official First Name:
STEPHANIE
Authorized Official Middle Name:
JOHNSON
Authorized Official Title or Position:
SLP/CLINICAL DIRECTOR
Authorized Official Telephone Number:
281-403-5437

Provider Taxonomy Codes

  • Taxonomy code: 225X00000X , with the licence number:  109759 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 235Z00000X , with the licence number: 100073 , 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: 162817401 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 87850T . This is a "BCBS (0080JN)" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 4858700 . This is a "CIGNA PROVIDER NUMBER" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 7694643 . This is a "AETNA PROVIDER NUMBER" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




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