Provider Demographics
NPI:1740599745
Name:SOUTHERN SPEECH, PLLC
Entity Type:Organization
Organization Name:SOUTHERN SPEECH, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SPEECH LANGUAGE PATHOLOGIST
Authorized Official - Prefix:MS
Authorized Official - First Name:CAPRICE
Authorized Official - Middle Name:L
Authorized Official - Last Name:MCCAREY-DODDS
Authorized Official - Suffix:
Authorized Official - Credentials:MS, CCC/SLP
Authorized Official - Phone:979-248-7369
Mailing Address - Street 1:109 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:SWEENY
Mailing Address - State:TX
Mailing Address - Zip Code:77480-3005
Mailing Address - Country:US
Mailing Address - Phone:979-248-7369
Mailing Address - Fax:877-335-8374
Practice Address - Street 1:109 N MAIN ST
Practice Address - Street 2:
Practice Address - City:SWEENY
Practice Address - State:TX
Practice Address - Zip Code:77480-3005
Practice Address - Country:US
Practice Address - Phone:979-248-7369
Practice Address - Fax:877-335-8374
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-26
Last Update Date:2021-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX19765261QH0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0700XAmbulatory Health Care FacilitiesClinic/CenterHearing and Speech
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX219316101Medicaid