Provider Demographics
NPI:1083435515
Name:BOOMTOWN THERAPY LLC
Entity type:Organization
Organization Name:BOOMTOWN THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COMPANY OWNER, FOUNDER
Authorized Official - Prefix:
Authorized Official - First Name:MEGAN
Authorized Official - Middle Name:
Authorized Official - Last Name:ZIGLER
Authorized Official - Suffix:
Authorized Official - Credentials:CCC-SLP
Authorized Official - Phone:832-371-7883
Mailing Address - Street 1:525 WOODLAND SQUARE BLVD STE 250
Mailing Address - Street 2:
Mailing Address - City:CONROE
Mailing Address - State:TX
Mailing Address - Zip Code:77384-2212
Mailing Address - Country:US
Mailing Address - Phone:832-371-7883
Mailing Address - Fax:
Practice Address - Street 1:525 WOODLAND SQUARE BLVD STE 250
Practice Address - Street 2:
Practice Address - City:CONROE
Practice Address - State:TX
Practice Address - Zip Code:77384-2212
Practice Address - Country:US
Practice Address - Phone:832-371-7883
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-10-17
Last Update Date:2024-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty