Provider Demographics
NPI:1114644580
Name:FLOURISH SPEECH THERAPY
Entity Type:Organization
Organization Name:FLOURISH SPEECH THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SPEECH PATHOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:REBECCA
Authorized Official - Middle Name:
Authorized Official - Last Name:FONSECA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:806-543-1677
Mailing Address - Street 1:3501 CRESTMONT DR
Mailing Address - Street 2:
Mailing Address - City:MIDLAND
Mailing Address - State:TX
Mailing Address - Zip Code:79707-4203
Mailing Address - Country:US
Mailing Address - Phone:806-543-1677
Mailing Address - Fax:432-216-5329
Practice Address - Street 1:3401 GREENBRIAR STE 100
Practice Address - Street 2:
Practice Address - City:MIDLAND
Practice Address - State:TX
Practice Address - Zip Code:79707-4653
Practice Address - Country:US
Practice Address - Phone:432-363-5422
Practice Address - Fax:432-216-5329
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-10-25
Last Update Date:2022-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty