Provider Demographics
NPI:1720732126
Name:LIGHT OF MINE SPEECH THERAPY, PLLC
Entity type:Organization
Organization Name:LIGHT OF MINE SPEECH THERAPY, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SPEECH-LANGUAGE PATHOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:ANGELICA
Authorized Official - Middle Name:
Authorized Official - Last Name:ADAME
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:346-812-7959
Mailing Address - Street 1:PO BOX 162
Mailing Address - Street 2:
Mailing Address - City:WALLER
Mailing Address - State:TX
Mailing Address - Zip Code:77484-0162
Mailing Address - Country:US
Mailing Address - Phone:346-812-7959
Mailing Address - Fax:
Practice Address - Street 1:17844 MOUND RD STE A
Practice Address - Street 2:
Practice Address - City:CYPRESS
Practice Address - State:TX
Practice Address - Zip Code:77433-4838
Practice Address - Country:US
Practice Address - Phone:346-812-7959
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-02-05
Last Update Date:2024-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty