Provider Demographics
NPI:1992283691
Name:806 SPEECH AND FEEDING THERAPY PLLC
Entity type:Organization
Organization Name:806 SPEECH AND FEEDING THERAPY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SPEECH PATHOLOGIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:STACIE
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:NEFFENDORF
Authorized Official - Suffix:
Authorized Official - Credentials:MS, CCC-SLP
Authorized Official - Phone:806-445-2899
Mailing Address - Street 1:5707 77TH ST
Mailing Address - Street 2:
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79424-2403
Mailing Address - Country:US
Mailing Address - Phone:806-445-2899
Mailing Address - Fax:
Practice Address - Street 1:5707 77TH ST
Practice Address - Street 2:
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79424-2403
Practice Address - Country:US
Practice Address - Phone:806-445-2899
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-08-03
Last Update Date:2018-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX106088251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health