Provider Demographics
NPI:1093167918
Name:LONESTAR SPEECH THERAPY, PLLC
Entity Type:Organization
Organization Name:LONESTAR SPEECH THERAPY, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ALYSON
Authorized Official - Middle Name:DAWN
Authorized Official - Last Name:REVES
Authorized Official - Suffix:
Authorized Official - Credentials:MS, CCC-SLP
Authorized Official - Phone:817-937-1522
Mailing Address - Street 1:10401 COUNTY ROAD 1016
Mailing Address - Street 2:
Mailing Address - City:BURLESON
Mailing Address - State:TX
Mailing Address - Zip Code:76028-7625
Mailing Address - Country:US
Mailing Address - Phone:817-937-1522
Mailing Address - Fax:866-606-8577
Practice Address - Street 1:10401 COUNTY ROAD 1016
Practice Address - Street 2:
Practice Address - City:BURLESON
Practice Address - State:TX
Practice Address - Zip Code:76028-7625
Practice Address - Country:US
Practice Address - Phone:817-937-1522
Practice Address - Fax:866-606-8577
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-07-02
Last Update Date:2016-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX101675261QH0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0700XAmbulatory Health Care FacilitiesClinic/CenterHearing and Speech