Provider Demographics
NPI:1700206505
Name:LANDECK, VIVIAN
Entity Type:Individual
Prefix:
First Name:VIVIAN
Middle Name:
Last Name:LANDECK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3120 SOUTHWEST FWY
Mailing Address - Street 2:SUITE 612
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77098-4509
Mailing Address - Country:US
Mailing Address - Phone:713-979-3800
Mailing Address - Fax:713-979-3806
Practice Address - Street 1:3120 SOUTHWEST FWY
Practice Address - Street 2:SUITE 612
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77098-4509
Practice Address - Country:US
Practice Address - Phone:713-979-3800
Practice Address - Fax:713-979-3806
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-18
Last Update Date:2014-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX370032355S0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant