Provider Demographics
NPI:1326084864
Name:FOUNTAIN, DARLA R (SLP)
Entity type:Individual
Prefix:
First Name:DARLA
Middle Name:R
Last Name:FOUNTAIN
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1409 OVERLOOK DR
Mailing Address - Street 2:
Mailing Address - City:KAUFMAN
Mailing Address - State:TX
Mailing Address - Zip Code:75142-3818
Mailing Address - Country:US
Mailing Address - Phone:903-826-7380
Mailing Address - Fax:214-889-9580
Practice Address - Street 1:1409 OVERLOOK DR
Practice Address - Street 2:
Practice Address - City:KAUFMAN
Practice Address - State:TX
Practice Address - Zip Code:75142-3818
Practice Address - Country:US
Practice Address - Phone:903-826-7380
Practice Address - Fax:214-889-9580
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-22
Last Update Date:2025-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX14573235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX089225901Medicaid
TX528367OtherBLUE CROSS
AR118613721Medicaid
AR97971OtherBLUE CROSS