Provider Demographics
NPI:1992437073
Name:PLAYHOUSE SPEECH THERAPY, PLLC
Entity type:Organization
Organization Name:PLAYHOUSE SPEECH THERAPY, PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:SPEECH LANGUAGE PATHOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:JENCY
Authorized Official - Middle Name:
Authorized Official - Last Name:CHACKO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:832-540-2466
Mailing Address - Street 1:2605 SAGEBRUSH DR STE 108
Mailing Address - Street 2:
Mailing Address - City:FLOWER MOUND
Mailing Address - State:TX
Mailing Address - Zip Code:75028-2739
Mailing Address - Country:US
Mailing Address - Phone:469-771-1311
Mailing Address - Fax:
Practice Address - Street 1:2605 SAGEBRUSH DR STE 108
Practice Address - Street 2:
Practice Address - City:FLOWER MOUND
Practice Address - State:TX
Practice Address - Zip Code:75028-2739
Practice Address - Country:US
Practice Address - Phone:469-771-1311
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-06-28
Last Update Date:2023-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty