Provider Demographics
NPI:1598372542
Name:FALKENBERG, MARY MAGDALEN NAMASIKU (SLPA)
Entity type:Individual
Prefix:
First Name:MARY MAGDALEN
Middle Name:NAMASIKU
Last Name:FALKENBERG
Suffix:
Gender:F
Credentials:SLPA
Other - Prefix:
Other - First Name:MARY
Other - Middle Name:
Other - Last Name:FALKENBERG
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:SLPA
Mailing Address - Street 1:1400 PRESTON RD STE 300
Mailing Address - Street 2:
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75093-3603
Mailing Address - Country:US
Mailing Address - Phone:972-755-9765
Mailing Address - Fax:214-602-3260
Practice Address - Street 1:1400 PRESTON RD STE 300
Practice Address - Street 2:
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75093-3603
Practice Address - Country:US
Practice Address - Phone:972-755-9765
Practice Address - Fax:214-602-3260
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-24
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX414922355S0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language AssistantGroup - Single Specialty