Provider Demographics
NPI:1215708797
Name:TINY BUT MIGHTY NICU TRANSITION PROGRAM, PLLC
Entity type:Organization
Organization Name:TINY BUT MIGHTY NICU TRANSITION PROGRAM, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SPEECH PATHOLOGIST, OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GINA
Authorized Official - Middle Name:
Authorized Official - Last Name:PISKE
Authorized Official - Suffix:
Authorized Official - Credentials:MS-CCC/SLP
Authorized Official - Phone:214-937-5350
Mailing Address - Street 1:1112 SEMINOLE DR
Mailing Address - Street 2:
Mailing Address - City:RICHARDSON
Mailing Address - State:TX
Mailing Address - Zip Code:75080-3931
Mailing Address - Country:US
Mailing Address - Phone:214-937-5350
Mailing Address - Fax:469-838-6488
Practice Address - Street 1:1112 SEMINOLE DR
Practice Address - Street 2:
Practice Address - City:RICHARDSON
Practice Address - State:TX
Practice Address - Zip Code:75080-3931
Practice Address - Country:US
Practice Address - Phone:214-937-5350
Practice Address - Fax:469-838-6488
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-01-12
Last Update Date:2024-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty