Provider Demographics
NPI:1851179626
Name:LAKEVIEW SPEECH AND LANGUAGE THERAPY
Entity Type:Organization
Organization Name:LAKEVIEW SPEECH AND LANGUAGE THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SPEECH LANGUAGE PATHOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:
Authorized Official - Last Name:HENDRICKS
Authorized Official - Suffix:
Authorized Official - Credentials:MHS, CCC-SLP
Authorized Official - Phone:817-932-3535
Mailing Address - Street 1:3400 FURLONG DR E
Mailing Address - Street 2:
Mailing Address - City:FLOWER MOUND
Mailing Address - State:TX
Mailing Address - Zip Code:75022-4767
Mailing Address - Country:US
Mailing Address - Phone:817-932-3535
Mailing Address - Fax:
Practice Address - Street 1:2605 SAGEBRUSH DR STE 206
Practice Address - Street 2:
Practice Address - City:FLOWER MOUND
Practice Address - State:TX
Practice Address - Zip Code:75028-2739
Practice Address - Country:US
Practice Address - Phone:940-241-0245
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-09-21
Last Update Date:2023-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0700XAmbulatory Health Care FacilitiesClinic/CenterHearing and Speech