Provider Demographics
NPI:1831691252
Name:DUBOIS, TRICIA RENEE (BS, SLP-ASSISTANT)
Entity type:Individual
Prefix:
First Name:TRICIA
Middle Name:RENEE
Last Name:DUBOIS
Suffix:
Gender:F
Credentials:BS, SLP-ASSISTANT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1600 AIRPORT FWY STE 372
Mailing Address - Street 2:
Mailing Address - City:BEDFORD
Mailing Address - State:TX
Mailing Address - Zip Code:76022-6873
Mailing Address - Country:US
Mailing Address - Phone:817-595-2955
Mailing Address - Fax:817-595-5764
Practice Address - Street 1:1600 AIRPORT FWY STE 372
Practice Address - Street 2:
Practice Address - City:BEDFORD
Practice Address - State:TX
Practice Address - Zip Code:76022-6873
Practice Address - Country:US
Practice Address - Phone:817-595-2955
Practice Address - Fax:817-595-5764
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-01
Last Update Date:2018-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX369182355S0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant