Provider Demographics
NPI:1578918397
Name:WORTHY, JUSTIN (SLP-ASSISTANT)
Entity Type:Individual
Prefix:
First Name:JUSTIN
Middle Name:
Last Name:WORTHY
Suffix:
Gender:M
Credentials:SLP-ASSISTANT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9767 PAGEWOOD LN
Mailing Address - Street 2:APT 616
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77042-5518
Mailing Address - Country:US
Mailing Address - Phone:413-636-2450
Mailing Address - Fax:
Practice Address - Street 1:6666 HARWIN DR
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77036-2292
Practice Address - Country:US
Practice Address - Phone:713-429-1176
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-04-29
Last Update Date:2016-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN360722355S0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant