Provider Demographics
NPI:1417579558
Name:FORT WORTH CHILDREN'S SPEECH AND FEEDING THERAPY, PLLC
Entity Type:Organization
Organization Name:FORT WORTH CHILDREN'S SPEECH AND FEEDING THERAPY, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SPEECH LANGUAGE PATHOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:KRISTEN
Authorized Official - Middle Name:
Authorized Official - Last Name:GAFFNEY
Authorized Official - Suffix:
Authorized Official - Credentials:MS, CCC-SLP
Authorized Official - Phone:925-209-4334
Mailing Address - Street 1:4417 INWOOD RD
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76109-5008
Mailing Address - Country:US
Mailing Address - Phone:925-209-4334
Mailing Address - Fax:
Practice Address - Street 1:3631 S HILLS AVE
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76109-2754
Practice Address - Country:US
Practice Address - Phone:925-209-4334
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-05-12
Last Update Date:2020-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty