Provider Demographics
NPI:1700275179
Name:PARKINSON PLACE SPEECHTHERAPY PLLC
Entity Type:Organization
Organization Name:PARKINSON PLACE SPEECHTHERAPY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:REBECCA
Authorized Official - Middle Name:ASBILLE
Authorized Official - Last Name:MORGAN
Authorized Official - Suffix:
Authorized Official - Credentials:MS,CCC-SLP
Authorized Official - Phone:817-988-5879
Mailing Address - Street 1:2129 PORTWOOD WAY
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76179-6634
Mailing Address - Country:US
Mailing Address - Phone:817-988-5879
Mailing Address - Fax:844-917-2767
Practice Address - Street 1:2129 PORTWOOD WAY
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76179-6634
Practice Address - Country:US
Practice Address - Phone:817-988-5879
Practice Address - Fax:844-917-2767
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-22
Last Update Date:2022-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX16011235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX399192Medicare UPIN