Provider Demographics
NPI:1922879170
Name:DEAVITT, REILLY HOPE
Entity Type:Individual
Prefix:
First Name:REILLY
Middle Name:HOPE
Last Name:DEAVITT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2121 MIDWAY RD STE 145
Mailing Address - Street 2:
Mailing Address - City:CARROLLTON
Mailing Address - State:TX
Mailing Address - Zip Code:75006-5263
Mailing Address - Country:US
Mailing Address - Phone:972-885-1550
Mailing Address - Fax:
Practice Address - Street 1:2121 MIDWAY RD
Practice Address - Street 2:
Practice Address - City:CARROLLTON
Practice Address - State:TX
Practice Address - Zip Code:75006-5262
Practice Address - Country:US
Practice Address - Phone:972-885-1550
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-15
Last Update Date:2024-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX122023235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist