| NPI | 1417447905 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SKY MIRANDA Billing And Credentialing Manager 469-971-3830 |
| Organization Subpart ? | No |
| Primary Taxonomy | 235Z00000X Speech-Language Pathologist, |
| Enumeration Date | 2018-05-10 |
| Last Update Date | 2022-12-05 |