Provider Demographics
NPI:1003708686
Name:MIKOLAS, TORRI REANN
Entity type:Individual
Prefix:
First Name:TORRI
Middle Name:REANN
Last Name:MIKOLAS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 772
Mailing Address - Street 2:
Mailing Address - City:SEADRIFT
Mailing Address - State:TX
Mailing Address - Zip Code:77983-0772
Mailing Address - Country:US
Mailing Address - Phone:361-649-1109
Mailing Address - Fax:
Practice Address - Street 1:1512 JACKSON ST
Practice Address - Street 2:
Practice Address - City:PORT LAVACA
Practice Address - State:TX
Practice Address - Zip Code:77979-4601
Practice Address - Country:US
Practice Address - Phone:361-552-3317
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-07-17
Last Update Date:2025-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX123738235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist