Provider Demographics
NPI:1215655154
Name:CONWELL, PHILLIP (MS, SLP-CCC)
Entity type:Individual
Prefix:MR
First Name:PHILLIP
Middle Name:
Last Name:CONWELL
Suffix:
Gender:M
Credentials:MS, SLP-CCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22319 BRIDGESTONE PALM CT
Mailing Address - Street 2:
Mailing Address - City:SPRING
Mailing Address - State:TX
Mailing Address - Zip Code:77388-2891
Mailing Address - Country:US
Mailing Address - Phone:281-658-2285
Mailing Address - Fax:
Practice Address - Street 1:3030 ROSEFIELD DR
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77080-2610
Practice Address - Country:US
Practice Address - Phone:713-251-4142
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-17
Last Update Date:2022-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX112797235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist