Provider Demographics
NPI:1366063836
Name:ORMISTON, ISABELLE MARIE (MA CCC-SLP)
Entity type:Individual
Prefix:
First Name:ISABELLE
Middle Name:MARIE
Last Name:ORMISTON
Suffix:
Gender:F
Credentials:MA CCC-SLP
Other - Prefix:
Other - First Name:ISABELLE
Other - Middle Name:
Other - Last Name:ORMISTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA CCC-SLP
Mailing Address - Street 1:1652 KELLER PARKWAY
Mailing Address - Street 2:SUITE 100
Mailing Address - City:KELLER
Mailing Address - State:TX
Mailing Address - Zip Code:76248-3876
Mailing Address - Country:US
Mailing Address - Phone:817-562-3111
Mailing Address - Fax:817-562-3114
Practice Address - Street 1:1652 KELLER PKWY
Practice Address - Street 2:STE 100
Practice Address - City:KELLER
Practice Address - State:TX
Practice Address - Zip Code:76248-3876
Practice Address - Country:US
Practice Address - Phone:817-562-3111
Practice Address - Fax:817-562-3114
Is Sole Proprietor?:No
Enumeration Date:2020-05-06
Last Update Date:2022-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX235Z00000X
TX116658235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX116658OtherSTATE LICENSE