Provider Demographics
NPI:1841697927
Name:DRAGONFLY SPEECH LANGUAGE SERVICES/PLLC
Entity type:Organization
Organization Name:DRAGONFLY SPEECH LANGUAGE SERVICES/PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MEMBER
Authorized Official - Prefix:MS
Authorized Official - First Name:CECILIA
Authorized Official - Middle Name:NORWOOD
Authorized Official - Last Name:WISBRUN
Authorized Official - Suffix:
Authorized Official - Credentials:MA, CCC-SLP
Authorized Official - Phone:512-966-0535
Mailing Address - Street 1:PO BOX 2004
Mailing Address - Street 2:
Mailing Address - City:LIBERTY HILL
Mailing Address - State:TX
Mailing Address - Zip Code:78642-2004
Mailing Address - Country:US
Mailing Address - Phone:512-966-0535
Mailing Address - Fax:
Practice Address - Street 1:105 FALLWELL ST
Practice Address - Street 2:
Practice Address - City:LIBERTY HILL
Practice Address - State:TX
Practice Address - Zip Code:78642-4267
Practice Address - Country:US
Practice Address - Phone:512-966-0535
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-12-04
Last Update Date:2014-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty