Provider Demographics
NPI:1922341213
Name:STAR LIGHT SPEECH THERAPY SERVICES
Entity Type:Organization
Organization Name:STAR LIGHT SPEECH THERAPY SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:EDDWADO
Authorized Official - Middle Name:
Authorized Official - Last Name:PERKIN
Authorized Official - Suffix:
Authorized Official - Credentials:MS CCC-SLP
Authorized Official - Phone:773-640-8340
Mailing Address - Street 1:1308 MATTHEW DR
Mailing Address - Street 2:
Mailing Address - City:MESQUITE
Mailing Address - State:TX
Mailing Address - Zip Code:75149-7700
Mailing Address - Country:US
Mailing Address - Phone:773-640-8340
Mailing Address - Fax:
Practice Address - Street 1:1308 MATTHEW DR
Practice Address - Street 2:
Practice Address - City:MESQUITE
Practice Address - State:TX
Practice Address - Zip Code:75149-7700
Practice Address - Country:US
Practice Address - Phone:773-640-8340
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-04-04
Last Update Date:2013-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX105956235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty