Provider Demographics
NPI:1205503026
Name:HERRON, AIMEE (CCC-SLP)
Entity type:Individual
Prefix:
First Name:AIMEE
Middle Name:
Last Name:HERRON
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2728 MCKINNON ST APT 1519
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75201-1647
Mailing Address - Country:US
Mailing Address - Phone:678-852-1384
Mailing Address - Fax:
Practice Address - Street 1:2350 AIRPORT FWY STE 455
Practice Address - Street 2:
Practice Address - City:BEDFORD
Practice Address - State:TX
Practice Address - Zip Code:76022-4011
Practice Address - Country:US
Practice Address - Phone:817-508-0030
Practice Address - Fax:877-267-4771
Is Sole Proprietor?:No
Enumeration Date:2021-08-28
Last Update Date:2021-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX112510235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist