Provider Demographics
NPI:1508504762
Name:SPEAK LIFE SPEECH PATHOLOGY, PLLC
Entity Type:Organization
Organization Name:SPEAK LIFE SPEECH PATHOLOGY, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CARA
Authorized Official - Middle Name:J
Authorized Official - Last Name:RUSSELL
Authorized Official - Suffix:
Authorized Official - Credentials:SLP
Authorized Official - Phone:832-257-2905
Mailing Address - Street 1:4625 NORTH FWY STE 107
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77022-2929
Mailing Address - Country:US
Mailing Address - Phone:832-257-2905
Mailing Address - Fax:
Practice Address - Street 1:4625 NORTH FWY STE 107
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77022-2929
Practice Address - Country:US
Practice Address - Phone:832-257-2905
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-05-26
Last Update Date:2022-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty