Provider Demographics
NPI:1194961888
Name:SPEECH, LANGUAGE, & AUDITORY LEARNING, PLLC
Entity type:Organization
Organization Name:SPEECH, LANGUAGE, & AUDITORY LEARNING, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SPEECH-LANGUAGE PATHOLOGIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:SUZANNE
Authorized Official - Middle Name:COUCH
Authorized Official - Last Name:HERMAN
Authorized Official - Suffix:
Authorized Official - Credentials:CCC/SLP
Authorized Official - Phone:903-581-5421
Mailing Address - Street 1:2117 S FLEISHEL AVE
Mailing Address - Street 2:
Mailing Address - City:TYLER
Mailing Address - State:TX
Mailing Address - Zip Code:75701-4440
Mailing Address - Country:US
Mailing Address - Phone:903-581-5421
Mailing Address - Fax:903-581-4515
Practice Address - Street 1:2117 S FLEISHEL AVE
Practice Address - Street 2:
Practice Address - City:TYLER
Practice Address - State:TX
Practice Address - Zip Code:75701-4440
Practice Address - Country:US
Practice Address - Phone:903-581-5421
Practice Address - Fax:903-581-4515
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-12-30
Last Update Date:2012-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX11594261QH0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0700XAmbulatory Health Care FacilitiesClinic/CenterHearing and Speech
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1497803688OtherNPI INDIVIDUAL
TX1609080613OtherNPI GROUP DBA
TX005616001Medicaid