Provider Demographics
NPI:1447943204
Name:DYSPHAGIA THERAPY PLUS CM, LLC
Entity type:Organization
Organization Name:DYSPHAGIA THERAPY PLUS CM, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SPEECH-LANGUAGE PATHOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:GILDA
Authorized Official - Middle Name:LETRICA
Authorized Official - Last Name:JACK-JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:M ED CCC/SLP
Authorized Official - Phone:832-622-4929
Mailing Address - Street 1:5445 ALMEDA RD STE 450
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77004-7403
Mailing Address - Country:US
Mailing Address - Phone:832-622-4929
Mailing Address - Fax:713-673-5113
Practice Address - Street 1:5445 ALMEDA RD STE 450
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77004-7403
Practice Address - Country:US
Practice Address - Phone:832-622-4929
Practice Address - Fax:713-673-5113
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-05-30
Last Update Date:2023-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QH0700XAmbulatory Health Care FacilitiesClinic/CenterHearing and Speech
No235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty