Provider Demographics
NPI:1790298263
Name:ADKISON, RENEE WEBB
Entity Type:Individual
Prefix:
First Name:RENEE
Middle Name:WEBB
Last Name:ADKISON
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 1:5830 WIMBLEDON CT
Mailing Address - Street 2:
Mailing Address - City:MIDLOTHIAN
Mailing Address - State:TX
Mailing Address - Zip Code:76065-3916
Mailing Address - Country:US
Mailing Address - Phone:214-478-5147
Mailing Address - Fax:
Practice Address - Street 1:4300 SIGMA RD STE 130
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75244-4445
Practice Address - Country:US
Practice Address - Phone:972-756-0500
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-11-07
Last Update Date:2017-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX13221235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist