Provider Demographics
NPI:1437409018
Name:DOTSON, TREA (SLP ASST)
Entity Type:Individual
Prefix:
First Name:TREA
Middle Name:
Last Name:DOTSON
Suffix:
Gender:F
Credentials:SLP ASST
Other - Prefix:
Other - First Name:TREA
Other - Middle Name:
Other - Last Name:KYLE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:SLP-ASST
Mailing Address - Street 1:320 CUSTER ROAD
Mailing Address - Street 2:
Mailing Address - City:RICHARDSON
Mailing Address - State:TX
Mailing Address - Zip Code:75080-2703
Mailing Address - Country:US
Mailing Address - Phone:972-490-9055
Mailing Address - Fax:972-265-0392
Practice Address - Street 1:320 CUSTER ROAD
Practice Address - Street 2:
Practice Address - City:RICHARDSON
Practice Address - State:TX
Practice Address - Zip Code:75080-2703
Practice Address - Country:US
Practice Address - Phone:972-490-9055
Practice Address - Fax:972-265-0392
Is Sole Proprietor?:No
Enumeration Date:2012-09-11
Last Update Date:2013-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX35797235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist