Provider Demographics
NPI:1790928737
Name:LAND, PAULA HUMPHREYS (AUD)
Entity Type:Individual
Prefix:DR
First Name:PAULA
Middle Name:HUMPHREYS
Last Name:LAND
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 WEST INTERSTATE HWY 635
Mailing Address - Street 2:SUITE 360
Mailing Address - City:IRVING
Mailing Address - State:TX
Mailing Address - Zip Code:75063
Mailing Address - Country:US
Mailing Address - Phone:972-402-8404
Mailing Address - Fax:972-402-9401
Practice Address - Street 1:400 W INTERSTATE HIGHWAY 635
Practice Address - Street 2:SUITE 360
Practice Address - City:IRVING
Practice Address - State:TX
Practice Address - Zip Code:75063-3718
Practice Address - Country:US
Practice Address - Phone:972-402-8404
Practice Address - Fax:972-402-9401
Is Sole Proprietor?:No
Enumeration Date:2009-04-07
Last Update Date:2012-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX80202231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8L18303Medicare PIN