Provider Demographics
NPI:1992309421
Name:VICE VERSA SPEECH AND LANGUAGE SERVICES, PLLC
Entity type:Organization
Organization Name:VICE VERSA SPEECH AND LANGUAGE SERVICES, PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/SLP
Authorized Official - Prefix:
Authorized Official - First Name:DEBORAH
Authorized Official - Middle Name:
Authorized Official - Last Name:MODE
Authorized Official - Suffix:
Authorized Official - Credentials:MS, CCC-SLP
Authorized Official - Phone:469-320-1700
Mailing Address - Street 1:6230 N BELT LINE RD STE 300
Mailing Address - Street 2:
Mailing Address - City:IRVING
Mailing Address - State:TX
Mailing Address - Zip Code:75063-2657
Mailing Address - Country:US
Mailing Address - Phone:469-320-1700
Mailing Address - Fax:469-320-1732
Practice Address - Street 1:6230 N BELT LINE RD STE 300
Practice Address - Street 2:
Practice Address - City:IRVING
Practice Address - State:TX
Practice Address - Zip Code:75063-2657
Practice Address - Country:US
Practice Address - Phone:469-320-1700
Practice Address - Fax:469-320-1732
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-11-25
Last Update Date:2024-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty