Provider Demographics
NPI:1609411982
Name:SIGNATURE SPEECH THERAPY, LLC
Entity Type:Organization
Organization Name:SIGNATURE SPEECH THERAPY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SLP
Authorized Official - Prefix:
Authorized Official - First Name:BRITTNEY
Authorized Official - Middle Name:
Authorized Official - Last Name:MATHIAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:817-240-8949
Mailing Address - Street 1:2432 N FM 157
Mailing Address - Street 2:
Mailing Address - City:VENUS
Mailing Address - State:TX
Mailing Address - Zip Code:76084-3421
Mailing Address - Country:US
Mailing Address - Phone:817-240-8949
Mailing Address - Fax:
Practice Address - Street 1:2432 N FM 157
Practice Address - Street 2:
Practice Address - City:VENUS
Practice Address - State:TX
Practice Address - Zip Code:76084-3421
Practice Address - Country:US
Practice Address - Phone:817-240-8949
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-11-11
Last Update Date:2019-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty