Provider Demographics
NPI:1396408357
Name:MERRIFIELD, LENA (MA, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:LENA
Middle Name:
Last Name:MERRIFIELD
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:203 W TRINITY ST APT D
Mailing Address - Street 2:
Mailing Address - City:FORNEY
Mailing Address - State:TX
Mailing Address - Zip Code:75126-8560
Mailing Address - Country:US
Mailing Address - Phone:207-423-8806
Mailing Address - Fax:
Practice Address - Street 1:1011 FM 741
Practice Address - Street 2:
Practice Address - City:FORNEY
Practice Address - State:TX
Practice Address - Zip Code:75126-3910
Practice Address - Country:US
Practice Address - Phone:469-762-4305
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-18
Last Update Date:2021-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX116177235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist