Provider Demographics
NPI:1538421813
Name:LIFESPAN ASSESSMENT SPEECH THERAPY SERVICES
Entity type:Organization
Organization Name:LIFESPAN ASSESSMENT SPEECH THERAPY SERVICES
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/ SPEECH-PATHOLOGIST
Authorized Official - Prefix:MS
Authorized Official - First Name:KATHERINE
Authorized Official - Middle Name:ELIZABETH
Authorized Official - Last Name:MOUTON
Authorized Official - Suffix:
Authorized Official - Credentials:MS CCC-SLP
Authorized Official - Phone:832-738-0507
Mailing Address - Street 1:1544 SAWDUST RD
Mailing Address - Street 2:SUITE 105
Mailing Address - City:THE WOODLANDS
Mailing Address - State:TX
Mailing Address - Zip Code:77380-2929
Mailing Address - Country:US
Mailing Address - Phone:832-738-0507
Mailing Address - Fax:281-719-5962
Practice Address - Street 1:1544 SAWDUST RD
Practice Address - Street 2:SUITE 105
Practice Address - City:THE WOODLANDS
Practice Address - State:TX
Practice Address - Zip Code:77380-2929
Practice Address - Country:US
Practice Address - Phone:832-738-0507
Practice Address - Fax:281-719-5962
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-06-12
Last Update Date:2012-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX12119234235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty