Provider Demographics
NPI:1942848858
Name:ALTHEIDE, DRU ELIZABETH (SLP)
Entity Type:Individual
Prefix:
First Name:DRU
Middle Name:ELIZABETH
Last Name:ALTHEIDE
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5100 RANDOL MILL RD
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76112-1553
Mailing Address - Country:US
Mailing Address - Phone:817-548-3258
Mailing Address - Fax:844-618-2754
Practice Address - Street 1:5100 RANDOL MILL RD
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76112-1553
Practice Address - Country:US
Practice Address - Phone:817-548-3258
Practice Address - Fax:844-618-2754
Is Sole Proprietor?:No
Enumeration Date:2019-12-11
Last Update Date:2019-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX110383235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist