Provider Demographics
NPI:1639590524
Name:POTTS, DOLORES (DEE) (MS, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:DOLORES (DEE)
Middle Name:
Last Name:POTTS
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:DEE
Other - Middle Name:
Other - Last Name:POTTS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MS, CCC-SLP
Mailing Address - Street 1:2513 HIGH POINTE BLVD
Mailing Address - Street 2:
Mailing Address - City:MCKINNEY
Mailing Address - State:TX
Mailing Address - Zip Code:75071-2621
Mailing Address - Country:US
Mailing Address - Phone:469-450-5524
Mailing Address - Fax:
Practice Address - Street 1:2513 HIGH POINTE BLVD
Practice Address - Street 2:
Practice Address - City:MCKINNEY
Practice Address - State:TX
Practice Address - Zip Code:75071-2621
Practice Address - Country:US
Practice Address - Phone:469-450-5524
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-12-19
Last Update Date:2013-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX22483235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
12148286OtherASHA
TX22483OtherTSHA