Provider Demographics
NPI:1194468710
Name:SMALL, BILLIE C (MS)
Entity Type:Individual
Prefix:
First Name:BILLIE
Middle Name:C
Last Name:SMALL
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8252 LESLEY LN
Mailing Address - Street 2:
Mailing Address - City:WATAUGA
Mailing Address - State:TX
Mailing Address - Zip Code:76148-1118
Mailing Address - Country:US
Mailing Address - Phone:682-269-6158
Mailing Address - Fax:
Practice Address - Street 1:8252 LESLEY LN
Practice Address - Street 2:
Practice Address - City:WATAUGA
Practice Address - State:TX
Practice Address - Zip Code:76148-1118
Practice Address - Country:US
Practice Address - Phone:682-269-6158
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-20
Last Update Date:2022-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX16830235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist