Provider Demographics
NPI:1306588603
Name:THEROUX ORLANDO, IRIS L (SLP-CCC)
Entity type:Individual
Prefix:
First Name:IRIS
Middle Name:L
Last Name:THEROUX ORLANDO
Suffix:
Gender:F
Credentials:SLP-CCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2301 CAMBRIDGE CT S
Mailing Address - Street 2:
Mailing Address - City:LEAGUE CITY
Mailing Address - State:TX
Mailing Address - Zip Code:77573-5007
Mailing Address - Country:US
Mailing Address - Phone:832-385-5474
Mailing Address - Fax:
Practice Address - Street 1:402 LAUREL DR
Practice Address - Street 2:
Practice Address - City:FRIENDSWOOD
Practice Address - State:TX
Practice Address - Zip Code:77546-3925
Practice Address - Country:US
Practice Address - Phone:281-482-1267
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-04-08
Last Update Date:2022-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX116130235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1518089556Medicaid