Provider Demographics
NPI:1477795466
Name:BAYOU CITY SPEECH & LANGUAGE
Entity Type:Organization
Organization Name:BAYOU CITY SPEECH & LANGUAGE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SPEECH-LANGUAGE PATHOLOGIST
Authorized Official - Prefix:MS
Authorized Official - First Name:JULIE
Authorized Official - Middle Name:ALLISON
Authorized Official - Last Name:ROBERTS
Authorized Official - Suffix:
Authorized Official - Credentials:MS, CCC-SLP
Authorized Official - Phone:713-628-5160
Mailing Address - Street 1:5555 WEST LOOP S
Mailing Address - Street 2:STE 345
Mailing Address - City:BELLAIRE
Mailing Address - State:TX
Mailing Address - Zip Code:77401-2100
Mailing Address - Country:US
Mailing Address - Phone:713-628-5160
Mailing Address - Fax:
Practice Address - Street 1:5555 WEST LOOP S
Practice Address - Street 2:STE 345
Practice Address - City:BELLAIRE
Practice Address - State:TX
Practice Address - Zip Code:77401-2100
Practice Address - Country:US
Practice Address - Phone:713-628-5160
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-06
Last Update Date:2017-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX19296235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX178355701Medicaid
1558433094OtherNPI