Provider Demographics
NPI:1770731192
Name:CENTER FOR FUNCTIONAL COMMUNICATION PLLC
Entity type:Organization
Organization Name:CENTER FOR FUNCTIONAL COMMUNICATION PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:C
Authorized Official - Last Name:RODRIGUEZ
Authorized Official - Suffix:
Authorized Official - Credentials:MA, CCC-SLP
Authorized Official - Phone:832-563-3225
Mailing Address - Street 1:32443 WATERFORD CREST LN
Mailing Address - Street 2:
Mailing Address - City:FULSHEAR
Mailing Address - State:TX
Mailing Address - Zip Code:77441-3003
Mailing Address - Country:US
Mailing Address - Phone:832-563-3225
Mailing Address - Fax:281-346-8090
Practice Address - Street 1:32443 WATERFORD CREST LN
Practice Address - Street 2:
Practice Address - City:FULSHEAR
Practice Address - State:TX
Practice Address - Zip Code:77441-3003
Practice Address - Country:US
Practice Address - Phone:832-563-3225
Practice Address - Fax:281-346-8090
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-28
Last Update Date:2020-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX19877235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX177729401Medicaid
TX1023113198OtherINDIVIDUAL TX NPI