Provider Demographics
NPI:1316571003
Name:CUPP, SHAREE NICOLE (SLP ASSISTANT)
Entity Type:Individual
Prefix:
First Name:SHAREE
Middle Name:NICOLE
Last Name:CUPP
Suffix:
Gender:F
Credentials:SLP ASSISTANT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4351 FM 1195
Mailing Address - Street 2:
Mailing Address - City:MINERAL WELLS
Mailing Address - State:TX
Mailing Address - Zip Code:76067-0731
Mailing Address - Country:US
Mailing Address - Phone:940-745-0286
Mailing Address - Fax:
Practice Address - Street 1:6530 HAWKS CREEK CT STE 107
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76114-1164
Practice Address - Country:US
Practice Address - Phone:817-435-4631
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-03
Last Update Date:2020-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX361652355S0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant