| NPI | 1710355201 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LANA LOUISE AFSETH Speech Language Pathologist 972-342-0560 |
| Organization Subpart ? | No |
| Primary Taxonomy | 305R00000X Preferred Provider Organization (Licence: TX 103455) |
| Enumeration Date | 2015-09-14 |
| Last Update Date | 2015-09-14 |