Provider Demographics
NPI:1013599406
Name:WASSOM, ADRIA (MS CCC-SLP)
Entity Type:Individual
Prefix:
First Name:ADRIA
Middle Name:
Last Name:WASSOM
Suffix:
Gender:F
Credentials:MS CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9600 COIT RD APT 2922
Mailing Address - Street 2:
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75025-8258
Mailing Address - Country:US
Mailing Address - Phone:225-573-5407
Mailing Address - Fax:
Practice Address - Street 1:1750 VALLEY VIEW LN STE 450
Practice Address - Street 2:
Practice Address - City:FARMERS BRANCH
Practice Address - State:TX
Practice Address - Zip Code:75234-1388
Practice Address - Country:US
Practice Address - Phone:972-243-4102
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-25
Last Update Date:2024-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX111337235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist