Provider Demographics
NPI:1306581970
Name:BARTLEY, VERNON ETHAN (CCC/SLP)
Entity type:Individual
Prefix:
First Name:VERNON
Middle Name:ETHAN
Last Name:BARTLEY
Suffix:
Gender:M
Credentials:CCC/SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10039 BRIARWILD LN
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77080-7013
Mailing Address - Country:US
Mailing Address - Phone:832-851-5483
Mailing Address - Fax:
Practice Address - Street 1:3025 ELLINGTON ST
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77088-4558
Practice Address - Country:US
Practice Address - Phone:832-851-5483
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-28
Last Update Date:2022-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX14800235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist