Provider Demographics
NPI:1164559613
Name:BIRK, NEELY RAE (SLP)
Entity Type:Individual
Prefix:
First Name:NEELY
Middle Name:RAE
Last Name:BIRK
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3009 25TH ST
Mailing Address - Street 2:
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79410-2132
Mailing Address - Country:US
Mailing Address - Phone:806-785-8030
Mailing Address - Fax:
Practice Address - Street 1:3009 25TH ST
Practice Address - Street 2:
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79410-2132
Practice Address - Country:US
Practice Address - Phone:806-785-8030
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-28
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX676600Medicare Oscar/Certification
TX676564Medicare Oscar/Certification
TX00936XMedicare ID - Type UnspecifiedPART B GROUP NUMBER
TX676559Medicare Oscar/Certification
TX676555Medicare Oscar/Certification
TX676554Medicare Oscar/Certification
TX676626Medicare Oscar/Certification