Provider Demographics
NPI:1720210156
Name:FORT WORTH INDEPENDENT SCHOOL SYSTEM
Entity Type:Organization
Organization Name:FORT WORTH INDEPENDENT SCHOOL SYSTEM
Other - Org Name:SPEECH, LANGUAGE & HEARING SERVICES
Other - Org Type:Other Name
Authorized Official - Title/Position:AUDIOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:KATHLEEN
Authorized Official - Middle Name:ANNE
Authorized Official - Last Name:EVERSON
Authorized Official - Suffix:
Authorized Official - Credentials:AUD
Authorized Official - Phone:817-814-6449
Mailing Address - Street 1:5100 EL CAMPO AVE
Mailing Address - Street 2:SPEECH, LANGUAGE & HEARING SERVICES
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76107-4864
Mailing Address - Country:US
Mailing Address - Phone:817-814-6449
Mailing Address - Fax:817-814-6452
Practice Address - Street 1:5100 EL CAMPO AVE
Practice Address - Street 2:SPEECH, LANGUAGE & HEARING SERVICES
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76107-4864
Practice Address - Country:US
Practice Address - Phone:817-814-6449
Practice Address - Fax:817-814-6452
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-08-19
Last Update Date:2009-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX50124251300000X
TX50623251300000X
TX50573251300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)