Provider Demographics
NPI:1003362971
Name:UNIVERSITY OF HOUSTON
Entity Type:Organization
Organization Name:UNIVERSITY OF HOUSTON
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SPEECH-LANGUAGE PATHOLOGIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:BRITTNEY
Authorized Official - Middle Name:GOODMAN
Authorized Official - Last Name:PETTIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:713-517-2369
Mailing Address - Street 1:18202 TUSCANA SHORES DR
Mailing Address - Street 2:
Mailing Address - City:CYPRESS
Mailing Address - State:TX
Mailing Address - Zip Code:77433-4116
Mailing Address - Country:US
Mailing Address - Phone:713-517-2369
Mailing Address - Fax:
Practice Address - Street 1:18202 TUSCANA SHORES DR
Practice Address - Street 2:
Practice Address - City:CYPRESS
Practice Address - State:TX
Practice Address - Zip Code:77433-4116
Practice Address - Country:US
Practice Address - Phone:713-517-2369
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-30
Last Update Date:2016-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX106046235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty