Provider Demographics
NPI:1073241402
Name:WASIM, YOUSRAH
Entity Type:Individual
Prefix:
First Name:YOUSRAH
Middle Name:
Last Name:WASIM
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3002 COLONEL COURT DR
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:TX
Mailing Address - Zip Code:77406-6801
Mailing Address - Country:US
Mailing Address - Phone:281-781-6353
Mailing Address - Fax:
Practice Address - Street 1:3002 COLONEL COURT DR
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:TX
Practice Address - Zip Code:77406-6801
Practice Address - Country:US
Practice Address - Phone:281-781-6353
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-12
Last Update Date:2022-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
235Z00000X
TX118171235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist