Provider Demographics
NPI:1851788079
Name:NORTHEAST SPEECH PATHOLOGY, PLLC
Entity Type:Organization
Organization Name:NORTHEAST SPEECH PATHOLOGY, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, SOLE MBR
Authorized Official - Prefix:MRS
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:NICOLE
Authorized Official - Last Name:YOUNG
Authorized Official - Suffix:
Authorized Official - Credentials:CCC/SLP
Authorized Official - Phone:713-376-9640
Mailing Address - Street 1:21880 ROBERTS LN
Mailing Address - Street 2:
Mailing Address - City:NEW CANEY
Mailing Address - State:TX
Mailing Address - Zip Code:77357-4748
Mailing Address - Country:US
Mailing Address - Phone:713-376-9640
Mailing Address - Fax:281-689-5665
Practice Address - Street 1:23010 GABRIEL
Practice Address - Street 2:SUITE 105
Practice Address - City:NEW CANEY
Practice Address - State:TX
Practice Address - Zip Code:77357-4163
Practice Address - Country:US
Practice Address - Phone:713-376-9640
Practice Address - Fax:281-689-5665
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-04-26
Last Update Date:2016-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX103919235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty