Provider Demographics
NPI:1073110797
Name:SIDDIQUE, ADINA (ST)
Entity Type:Individual
Prefix:
First Name:ADINA
Middle Name:
Last Name:SIDDIQUE
Suffix:
Gender:F
Credentials:ST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6025 SPORTS VILLAGE RD
Mailing Address - Street 2:
Mailing Address - City:FRISCO
Mailing Address - State:TX
Mailing Address - Zip Code:75033-3505
Mailing Address - Country:US
Mailing Address - Phone:214-687-9374
Mailing Address - Fax:
Practice Address - Street 1:6025 SPORTS VILLAGE RD
Practice Address - Street 2:
Practice Address - City:FRISCO
Practice Address - State:TX
Practice Address - Zip Code:75033-3505
Practice Address - Country:US
Practice Address - Phone:214-687-9374
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-06
Last Update Date:2020-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX117444235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist