Provider Demographics
NPI:1306304753
Name:KID PRO, PLLC
Entity type:Organization
Organization Name:KID PRO, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/SLP
Authorized Official - Prefix:
Authorized Official - First Name:ASHLEY
Authorized Official - Middle Name:ELIZABETH
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:MS, CCC-SLP
Authorized Official - Phone:972-755-9157
Mailing Address - Street 1:6510 ABRAMS RD STE 315
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75231-7280
Mailing Address - Country:US
Mailing Address - Phone:972-755-9157
Mailing Address - Fax:
Practice Address - Street 1:6510 ABRAMS RD STE 315
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75231-7280
Practice Address - Country:US
Practice Address - Phone:972-755-9157
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-03-05
Last Update Date:2022-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0700XAmbulatory Health Care FacilitiesClinic/CenterHearing and Speech
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX114244OtherTX SLP LICENSE