Provider Demographics
NPI:1992801831
Name:SPEECH SERVICES DIRECT
Entity type:Organization
Organization Name:SPEECH SERVICES DIRECT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SPEECH PATHOLOGIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:JACQUELINE
Authorized Official - Middle Name:HERNANDEZ
Authorized Official - Last Name:REW
Authorized Official - Suffix:
Authorized Official - Credentials:MED, MS, CCC-SS
Authorized Official - Phone:281-686-0460
Mailing Address - Street 1:14403 TWISTED OAK LN
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77079
Mailing Address - Country:US
Mailing Address - Phone:281-870-8489
Mailing Address - Fax:281-782-0087
Practice Address - Street 1:19627 I45 NORTH
Practice Address - Street 2:SUITE 105
Practice Address - City:SPRING
Practice Address - State:TX
Practice Address - Zip Code:77388
Practice Address - Country:US
Practice Address - Phone:281-288-1061
Practice Address - Fax:281-288-1081
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX15652235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty