Provider Demographics
NPI:1245912963
Name:DAUGHTRY, AUGUSTA HELENE
Entity type:Individual
Prefix:
First Name:AUGUSTA
Middle Name:HELENE
Last Name:DAUGHTRY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16608 COUNTY ROAD 3111
Mailing Address - Street 2:
Mailing Address - City:GLADEWATER
Mailing Address - State:TX
Mailing Address - Zip Code:75647-9309
Mailing Address - Country:US
Mailing Address - Phone:903-841-6172
Mailing Address - Fax:
Practice Address - Street 1:16608 COUNTY ROAD 3111
Practice Address - Street 2:
Practice Address - City:GLADEWATER
Practice Address - State:TX
Practice Address - Zip Code:75647-9309
Practice Address - Country:US
Practice Address - Phone:903-841-6172
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-02
Last Update Date:2023-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX426452355S0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant