Provider Demographics
NPI:1083351266
Name:DUBOIS, NATALIE ANN (MED CCC-SLP)
Entity Type:Individual
Prefix:
First Name:NATALIE
Middle Name:ANN
Last Name:DUBOIS
Suffix:
Gender:F
Credentials:MED 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:PO BOX 5878
Mailing Address - Street 2:
Mailing Address - City:LONGVIEW
Mailing Address - State:TX
Mailing Address - Zip Code:75608-5878
Mailing Address - Country:US
Mailing Address - Phone:903-295-5170
Mailing Address - Fax:
Practice Address - Street 1:1701 PINE TREE RD
Practice Address - Street 2:
Practice Address - City:LONGVIEW
Practice Address - State:TX
Practice Address - Zip Code:75604-1909
Practice Address - Country:US
Practice Address - Phone:903-295-5151
Practice Address - Fax:903-295-1808
Is Sole Proprietor?:No
Enumeration Date:2022-05-18
Last Update Date:2022-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX12393235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist