Provider Demographics
NPI:1336803311
Name:PARK CITIES SPEECH, LANGUAGE & LEARNING
Entity Type:Organization
Organization Name:PARK CITIES SPEECH, LANGUAGE & LEARNING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:
Authorized Official - Last Name:WALLACE
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:214-368-8251
Mailing Address - Street 1:8100 LOMO ALTO DR STE 200
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75225-6545
Mailing Address - Country:US
Mailing Address - Phone:214-368-8251
Mailing Address - Fax:214-368-7765
Practice Address - Street 1:8100 LOMO ALTO DR STE 200
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75225-6545
Practice Address - Country:US
Practice Address - Phone:214-368-8251
Practice Address - Fax:214-368-7765
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-10-26
Last Update Date:2021-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty