Provider Demographics
NPI:1619162849
Name:CHILDREN'S LANGUAGE DEVELOPMENT CENTER
Entity Type:Organization
Organization Name:CHILDREN'S LANGUAGE DEVELOPMENT CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SPEECH LANGUAGE PATHOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:ELISSA
Authorized Official - Middle Name:B
Authorized Official - Last Name:WOODS
Authorized Official - Suffix:
Authorized Official - Credentials:MS CCC - SLP
Authorized Official - Phone:972-964-1500
Mailing Address - Street 1:2301 OHIO DRIVE
Mailing Address - Street 2:SUITE 130
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75093-3997
Mailing Address - Country:US
Mailing Address - Phone:972-964-1500
Mailing Address - Fax:972-964-1200
Practice Address - Street 1:2301 OHIO DRIVE
Practice Address - Street 2:SUITE 130
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75093-3997
Practice Address - Country:US
Practice Address - Phone:972-964-1500
Practice Address - Fax:972-964-1200
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-11
Last Update Date:2010-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX12908235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty