Provider Demographics
NPI:1558637330
Name:LOGOPEDIA THERAPY CLINIC, INC
Entity Type:Organization
Organization Name:LOGOPEDIA THERAPY CLINIC, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DALIA
Authorized Official - Middle Name:IRENE
Authorized Official - Last Name:GUTIERREZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:956-255-4154
Mailing Address - Street 1:3409 W STATE HIGHWAY 107
Mailing Address - Street 2:
Mailing Address - City:EDINBURG
Mailing Address - State:TX
Mailing Address - Zip Code:78539-2802
Mailing Address - Country:US
Mailing Address - Phone:956-255-4154
Mailing Address - Fax:956-255-4157
Practice Address - Street 1:848 MANZANILLA COURT
Practice Address - Street 2:SUITE 1
Practice Address - City:ELSA
Practice Address - State:TX
Practice Address - Zip Code:78543-2798
Practice Address - Country:US
Practice Address - Phone:956-255-4154
Practice Address - Fax:956-255-4157
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LOGOPEDIA THERAPY CLINIC, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-03-27
Last Update Date:2012-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2251P0200X, 225XP0200X, 235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty
No2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatricsGroup - Multi-Specialty
No225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatricsGroup - Multi-Specialty