Provider Demographics
NPI:1174267744
Name:IMPACTFUL SPEECH THERAPY PLLC
Entity Type:Organization
Organization Name:IMPACTFUL SPEECH THERAPY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SPEECH LANGUAGE PATHOLOGIST
Authorized Official - Prefix:MS
Authorized Official - First Name:SHATONYA
Authorized Official - Middle Name:N
Authorized Official - Last Name:PICKENS
Authorized Official - Suffix:
Authorized Official - Credentials:MED
Authorized Official - Phone:817-201-1013
Mailing Address - Street 1:7537 SWEET MEADOWS DR
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76123-1970
Mailing Address - Country:US
Mailing Address - Phone:817-423-4270
Mailing Address - Fax:
Practice Address - Street 1:7537 SWEET MEADOWS DR
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76123-1970
Practice Address - Country:US
Practice Address - Phone:817-423-4270
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-04-20
Last Update Date:2022-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty