Provider Demographics
NPI:1821858010
Name:GEORGETOWN SPEECH THERAPY
Entity Type:Organization
Organization Name:GEORGETOWN SPEECH THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO- OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BRIONA
Authorized Official - Middle Name:
Authorized Official - Last Name:DAUGHERTY
Authorized Official - Suffix:
Authorized Official - Credentials:MS CCC SLP
Authorized Official - Phone:760-443-2666
Mailing Address - Street 1:1990 CANYON SAGE PATH
Mailing Address - Street 2:
Mailing Address - City:ROUND ROCK
Mailing Address - State:TX
Mailing Address - Zip Code:78665-1265
Mailing Address - Country:US
Mailing Address - Phone:760-443-2666
Mailing Address - Fax:
Practice Address - Street 1:1990 CANYON SAGE PATH
Practice Address - Street 2:
Practice Address - City:ROUND ROCK
Practice Address - State:TX
Practice Address - Zip Code:78665-1265
Practice Address - Country:US
Practice Address - Phone:760-443-2666
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-03-22
Last Update Date:2024-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health