Provider Demographics
NPI:1528322591
Name:PHILLIPS, LIANE (SLP)
Entity type:Individual
Prefix:
First Name:LIANE
Middle Name:
Last Name:PHILLIPS
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:LIANE
Other - Middle Name:
Other - Last Name:ARBEZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:6126 GREEN JACKET DR
Mailing Address - Street 2:#1025
Mailing Address - City:FT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76137-6867
Mailing Address - Country:US
Mailing Address - Phone:817-228-0336
Mailing Address - Fax:817-442-0223
Practice Address - Street 1:2425 E SOUTHLAKE BLVD
Practice Address - Street 2:#100
Practice Address - City:SOUTHLAKE
Practice Address - State:TX
Practice Address - Zip Code:76092-6674
Practice Address - Country:US
Practice Address - Phone:817-442-0222
Practice Address - Fax:817-442-0223
Is Sole Proprietor?:No
Enumeration Date:2012-06-25
Last Update Date:2012-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX18242235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist