Provider Demographics
NPI:1023452471
Name:SPEECH PATHOLOGY SERVICES
Entity type:Organization
Organization Name:SPEECH PATHOLOGY SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:SALLY
Authorized Official - Middle Name:DAYNE
Authorized Official - Last Name:MCKEE
Authorized Official - Suffix:
Authorized Official - Credentials:MA CCC-SLP
Authorized Official - Phone:979-484-7450
Mailing Address - Street 1:547 WILLIAM D FITCH PKWY
Mailing Address - Street 2:102
Mailing Address - City:COLLEGE STATION
Mailing Address - State:TX
Mailing Address - Zip Code:77845-6161
Mailing Address - Country:US
Mailing Address - Phone:979-484-7450
Mailing Address - Fax:800-878-5664
Practice Address - Street 1:547 WILLIAM D FITCH PKWY
Practice Address - Street 2:102
Practice Address - City:COLLEGE STATION
Practice Address - State:TX
Practice Address - Zip Code:77845-6161
Practice Address - Country:US
Practice Address - Phone:979-484-7450
Practice Address - Fax:800-878-5664
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-04-28
Last Update Date:2013-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX104813235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty