Provider Demographics
NPI:1346571213
Name:SPEECH CHICK THERAPY
Entity Type:Organization
Organization Name:SPEECH CHICK THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SPEECH PATHOLOGIST/OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MELISSA
Authorized Official - Middle Name:KAREN
Authorized Official - Last Name:WARDEN
Authorized Official - Suffix:
Authorized Official - Credentials:MS SLP-CCC
Authorized Official - Phone:972-816-1013
Mailing Address - Street 1:2621 MOCKINGBIRD ST
Mailing Address - Street 2:
Mailing Address - City:ROYSE CITY
Mailing Address - State:TX
Mailing Address - Zip Code:75189-5420
Mailing Address - Country:US
Mailing Address - Phone:972-816-1013
Mailing Address - Fax:972-635-2289
Practice Address - Street 1:2621 MOCKINGBIRD ST
Practice Address - Street 2:
Practice Address - City:ROYSE CITY
Practice Address - State:TX
Practice Address - Zip Code:75189-5420
Practice Address - Country:US
Practice Address - Phone:972-816-1013
Practice Address - Fax:972-635-2289
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-01-15
Last Update Date:2010-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX24864235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty