Provider Demographics
NPI:1518486471
Name:THERAPEUTIC SPEECH CONNECTIONS
Entity Type:Organization
Organization Name:THERAPEUTIC SPEECH CONNECTIONS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SPEECH-LANGUAGE PATHOLOGIST
Authorized Official - Prefix:MS
Authorized Official - First Name:KELLIE
Authorized Official - Middle Name:NATASHA
Authorized Official - Last Name:WILSON
Authorized Official - Suffix:
Authorized Official - Credentials:MED
Authorized Official - Phone:713-732-4784
Mailing Address - Street 1:19126 QUARRY LAKES LANE
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:TX
Mailing Address - Zip Code:77407
Mailing Address - Country:US
Mailing Address - Phone:713-732-4784
Mailing Address - Fax:832-471-6914
Practice Address - Street 1:19126 QUARRY LAKES LANE
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:TX
Practice Address - Zip Code:77407
Practice Address - Country:US
Practice Address - Phone:713-732-4784
Practice Address - Fax:832-471-6914
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-09-12
Last Update Date:2017-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX102896235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty