Provider Demographics
NPI:1326658725
Name:INGRAM, DORY D (SLP)
Entity Type:Individual
Prefix:
First Name:DORY
Middle Name:D
Last Name:INGRAM
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 1:19613 LAKEHURST LOOP
Mailing Address - Street 2:
Mailing Address - City:SPICEWOOD
Mailing Address - State:TX
Mailing Address - Zip Code:78669-6542
Mailing Address - Country:US
Mailing Address - Phone:512-965-7235
Mailing Address - Fax:
Practice Address - Street 1:1620 MAGNOLIA ST
Practice Address - Street 2:
Practice Address - City:LIBERTY
Practice Address - State:TX
Practice Address - Zip Code:77575-3546
Practice Address - Country:US
Practice Address - Phone:512-965-7235
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-31
Last Update Date:2020-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist