Provider Demographics
NPI:1497845820
Name:PEDI PROS INC
Entity Type:Organization
Organization Name:PEDI PROS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:TERESA
Authorized Official - Middle Name:K
Authorized Official - Last Name:MANN
Authorized Official - Suffix:
Authorized Official - Credentials:MS CCC SLP
Authorized Official - Phone:915-633-8301
Mailing Address - Street 1:5640 MONTANA AVE
Mailing Address - Street 2:STE G
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79925-3329
Mailing Address - Country:US
Mailing Address - Phone:915-633-8301
Mailing Address - Fax:915-591-6696
Practice Address - Street 1:5640 MONTANA AVE
Practice Address - Street 2:STE G
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79925-3329
Practice Address - Country:US
Practice Address - Phone:915-633-8301
Practice Address - Fax:915-591-6696
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-14
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX16603235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty