Provider Demographics
NPI:1962597617
Name:THE SPEECH ENRICHMENT CENTER, LP
Entity type:Organization
Organization Name:THE SPEECH ENRICHMENT CENTER, LP
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:SLP/CLINICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:STEPHANIE
Authorized Official - Middle Name:JOHNSON
Authorized Official - Last Name:WHITE
Authorized Official - Suffix:
Authorized Official - Credentials:MA, CCC/SLP
Authorized Official - Phone:281-403-5437
Mailing Address - Street 1:6140 HIGHWAY 6 # 90
Mailing Address - Street 2:
Mailing Address - City:MISSOURI CITY
Mailing Address - State:TX
Mailing Address - Zip Code:77459-3802
Mailing Address - Country:US
Mailing Address - Phone:281-403-5437
Mailing Address - Fax:281-403-1002
Practice Address - Street 1:3424 FM 1092 RD
Practice Address - Street 2:SUITE 200
Practice Address - City:MISSOURI CITY
Practice Address - State:TX
Practice Address - Zip Code:77459-2285
Practice Address - Country:US
Practice Address - Phone:281-403-5437
Practice Address - Fax:281-403-1002
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-04
Last Update Date:2018-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX109759225X00000X
TX100073235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX162817401Medicaid
TX87850TOtherBCBS (0080JN)
TX4858700OtherCIGNA PROVIDER NUMBER
TX7694643OtherAETNA PROVIDER NUMBER
TX4858700OtherCIGNA PROVIDER NUMBER