Provider Demographics
NPI:1316153752
Name:ENNIS, DOROTHY FERN (BSE, TX LIC SLP)
Entity type:Individual
Prefix:MRS
First Name:DOROTHY
Middle Name:FERN
Last Name:ENNIS
Suffix:
Gender:F
Credentials:BSE, TX LIC SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9406 ARBOIS
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78254-5818
Mailing Address - Country:US
Mailing Address - Phone:210-681-3069
Mailing Address - Fax:
Practice Address - Street 1:8632 FREDERICKSBURG RD
Practice Address - Street 2:SUITE 212
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78240-1264
Practice Address - Country:US
Practice Address - Phone:210-696-5777
Practice Address - Fax:505-468-9476
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX13418235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist