Provider Demographics
NPI:1396517231
Name:IGNITE SPEECH THERAPY PLLC
Entity type:Organization
Organization Name:IGNITE SPEECH THERAPY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/SLP
Authorized Official - Prefix:
Authorized Official - First Name:MARIE
Authorized Official - Middle Name:
Authorized Official - Last Name:HERNANDEZ MCMANUS
Authorized Official - Suffix:
Authorized Official - Credentials:SLP
Authorized Official - Phone:469-231-4746
Mailing Address - Street 1:1330 S LLEWELLYN AVE
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75224-1405
Mailing Address - Country:US
Mailing Address - Phone:469-231-4746
Mailing Address - Fax:
Practice Address - Street 1:509 N WINNETKA AVE # 110
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75208-5141
Practice Address - Country:US
Practice Address - Phone:469-231-0795
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-10-24
Last Update Date:2023-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty