Provider Demographics
NPI:1124271325
Name:APPLES AND BANANAS INC.
Entity type:Organization
Organization Name:APPLES AND BANANAS INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SLP
Authorized Official - Prefix:MRS
Authorized Official - First Name:SHANNON
Authorized Official - Middle Name:LEWIS
Authorized Official - Last Name:SERVANCE
Authorized Official - Suffix:
Authorized Official - Credentials:MA CCC-SLP
Authorized Official - Phone:281-403-1900
Mailing Address - Street 1:4501 CARTWRIGHT RD
Mailing Address - Street 2:#301
Mailing Address - City:MISSOURI CITY
Mailing Address - State:TX
Mailing Address - Zip Code:77459-3534
Mailing Address - Country:US
Mailing Address - Phone:281-403-1900
Mailing Address - Fax:281-403-1910
Practice Address - Street 1:C4501 CARTWRIGHT RD
Practice Address - Street 2:#301
Practice Address - City:MISSOURI CITY
Practice Address - State:TX
Practice Address - Zip Code:77459-3534
Practice Address - Country:US
Practice Address - Phone:281-403-1900
Practice Address - Fax:281-403-1910
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-31
Last Update Date:2008-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX16446235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1851016Medicaid