Provider Demographics
NPI:1225706039
Name:IMMLER, LINDA KAREN (MS, CCC/SLP)
Entity Type:Individual
Prefix:
First Name:LINDA
Middle Name:KAREN
Last Name:IMMLER
Suffix:
Gender:F
Credentials:MS, CCC/SLP
Other - Prefix:
Other - First Name:KAREN
Other - Middle Name:DOSS
Other - Last Name:IMMLER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MS, CCC/SLP
Mailing Address - Street 1:5601 S 14TH ST
Mailing Address - Street 2:
Mailing Address - City:MIDLOTHIAN
Mailing Address - State:TX
Mailing Address - Zip Code:76065-2441
Mailing Address - Country:US
Mailing Address - Phone:214-364-9278
Mailing Address - Fax:
Practice Address - Street 1:710 S CEDAR RIDGE DR
Practice Address - Street 2:
Practice Address - City:DUNCANVILLE
Practice Address - State:TX
Practice Address - Zip Code:75137-2204
Practice Address - Country:US
Practice Address - Phone:972-708-2060
Practice Address - Fax:972-708-2093
Is Sole Proprietor?:No
Enumeration Date:2021-09-06
Last Update Date:2021-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX16057235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist