Provider Demographics
NPI:1598329971
Name:LEGACY SPEECH SERVICES L.L.C.
Entity Type:Organization
Organization Name:LEGACY SPEECH SERVICES L.L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARCELA
Authorized Official - Middle Name:
Authorized Official - Last Name:PADILLA
Authorized Official - Suffix:
Authorized Official - Credentials:MS, CCC-SLP
Authorized Official - Phone:201-213-2461
Mailing Address - Street 1:2026 WIRT RD STE 103B
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77055-1626
Mailing Address - Country:US
Mailing Address - Phone:832-980-7061
Mailing Address - Fax:832-644-0127
Practice Address - Street 1:2026 WIRT RD STE 103B
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77055-1626
Practice Address - Country:US
Practice Address - Phone:832-980-7061
Practice Address - Fax:832-644-0127
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LEGACY SPEECH SERVICES LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-04-30
Last Update Date:2019-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX3490674Medicaid