Provider Demographics
NPI:1073744074
Name:SPEECH & LANGUAGE THERAPY ASSOC., PC
Entity Type:Organization
Organization Name:SPEECH & LANGUAGE THERAPY ASSOC., PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:KRISTI
Authorized Official - Middle Name:M
Authorized Official - Last Name:HARM
Authorized Official - Suffix:
Authorized Official - Credentials:MS, CCC-SLP
Authorized Official - Phone:817-729-9506
Mailing Address - Street 1:605 INWOOD RD
Mailing Address - Street 2:
Mailing Address - City:AZLE
Mailing Address - State:TX
Mailing Address - Zip Code:76020-4818
Mailing Address - Country:US
Mailing Address - Phone:817-729-9506
Mailing Address - Fax:817-855-0039
Practice Address - Street 1:605 INWOOD RD
Practice Address - Street 2:
Practice Address - City:AZLE
Practice Address - State:TX
Practice Address - Zip Code:76020-4818
Practice Address - Country:US
Practice Address - Phone:817-729-9506
Practice Address - Fax:817-855-0039
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-08-07
Last Update Date:2009-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX100679235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX178365601Medicaid