Provider Demographics
NPI:1336309327
Name:PERMIAN BASIN SPEECH LANGUAGE AND LEARNING SERVICES INC
Entity Type:Organization
Organization Name:PERMIAN BASIN SPEECH LANGUAGE AND LEARNING SERVICES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SPEECH PATHOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:LISA
Authorized Official - Middle Name:
Authorized Official - Last Name:IRVIN
Authorized Official - Suffix:
Authorized Official - Credentials:MS
Authorized Official - Phone:432-570-4400
Mailing Address - Street 1:3300 N A ST
Mailing Address - Street 2:BUILDING 7-260
Mailing Address - City:MIDLAND
Mailing Address - State:TX
Mailing Address - Zip Code:79705-5421
Mailing Address - Country:US
Mailing Address - Phone:432-570-4400
Mailing Address - Fax:432-570-4460
Practice Address - Street 1:3300 N A ST
Practice Address - Street 2:BUILDING 7-260
Practice Address - City:MIDLAND
Practice Address - State:TX
Practice Address - Zip Code:79705-5421
Practice Address - Country:US
Practice Address - Phone:432-570-4400
Practice Address - Fax:432-570-4460
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-12
Last Update Date:2008-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX14147235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty