Provider Demographics
NPI:1386360352
Name:LIFE, JANIE (MS CCC-SLP)
Entity type:Individual
Prefix:
First Name:JANIE
Middle Name:
Last Name:LIFE
Suffix:
Gender:F
Credentials:MS CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:701 W BELT LINE RD
Mailing Address - Street 2:
Mailing Address - City:RICHARDSON
Mailing Address - State:TX
Mailing Address - Zip Code:75080-6015
Mailing Address - Country:US
Mailing Address - Phone:713-724-8828
Mailing Address - Fax:
Practice Address - Street 1:701 W BELT LINE RD
Practice Address - Street 2:
Practice Address - City:RICHARDSON
Practice Address - State:TX
Practice Address - Zip Code:75080-6015
Practice Address - Country:US
Practice Address - Phone:713-724-8828
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-10-12
Last Update Date:2022-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX112686235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist