Provider Demographics
NPI:1790292498
Name:KHALIL, ESRAA MOHAMED (CCC-SLP)
Entity Type:Individual
Prefix:
First Name:ESRAA
Middle Name:MOHAMED
Last Name:KHALIL
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:118 BRIAR OAK DR
Mailing Address - Street 2:
Mailing Address - City:MURPHY
Mailing Address - State:TX
Mailing Address - Zip Code:75094-3330
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1360 STAR CT # T1
Practice Address - Street 2:
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75074-7353
Practice Address - Country:US
Practice Address - Phone:469-573-0580
Practice Address - Fax:469-609-4667
Is Sole Proprietor?:Yes
Enumeration Date:2018-01-03
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX108587235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist