Provider Demographics
NPI:1386826162
Name:THE SPEECH CABOOSE
Entity Type:Organization
Organization Name:THE SPEECH CABOOSE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SPEECH LANGUAGE PATHOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAMS
Authorized Official - Middle Name:MORJAN
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:MED, CCC-SLP
Authorized Official - Phone:713-817-7764
Mailing Address - Street 1:6003 CRESTFORD PARK LN
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77084-6454
Mailing Address - Country:US
Mailing Address - Phone:713-817-7764
Mailing Address - Fax:281-345-4599
Practice Address - Street 1:6003 CRESTFORD PARK LN
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77084-6454
Practice Address - Country:US
Practice Address - Phone:713-817-7764
Practice Address - Fax:281-345-4599
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-03
Last Update Date:2007-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX100097251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health