Provider Demographics
NPI:1013986074
Name:DARDEN, FELICIA (PHD CCC-SLP)
Entity Type:Individual
Prefix:DR
First Name:FELICIA
Middle Name:
Last Name:DARDEN
Suffix:
Gender:F
Credentials:PHD CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P.O. BOX 57
Mailing Address - Street 2:
Mailing Address - City:GALVESTON
Mailing Address - State:TX
Mailing Address - Zip Code:77553
Mailing Address - Country:US
Mailing Address - Phone:409-242-6500
Mailing Address - Fax:409-497-4389
Practice Address - Street 1:928 BROADWAY
Practice Address - Street 2:
Practice Address - City:GALVESTON
Practice Address - State:TX
Practice Address - Zip Code:77550
Practice Address - Country:US
Practice Address - Phone:409-242-6500
Practice Address - Fax:402-497-4389
Is Sole Proprietor?:No
Enumeration Date:2006-03-14
Last Update Date:2017-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GASLP0006283235Z00000X
235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA6588880755AMedicaid