Provider Demographics
NPI:1609623248
Name:WILLOW TREE THERAPY GROUP, PLLC
Entity type:Organization
Organization Name:WILLOW TREE THERAPY GROUP, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SPEECH-LANGUAGE PATHOLOGIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:MEAGON
Authorized Official - Middle Name:BROUSSARD
Authorized Official - Last Name:GLASS
Authorized Official - Suffix:
Authorized Official - Credentials:MS, CCC-SLP
Authorized Official - Phone:214-585-8144
Mailing Address - Street 1:812 W MCDERMOTT DR # 1314
Mailing Address - Street 2:
Mailing Address - City:ALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:75013-6500
Mailing Address - Country:US
Mailing Address - Phone:214-585-8144
Mailing Address - Fax:
Practice Address - Street 1:1100 BLACKENHURST LN
Practice Address - Street 2:
Practice Address - City:ALLEN
Practice Address - State:TX
Practice Address - Zip Code:75002-3933
Practice Address - Country:US
Practice Address - Phone:214-585-8144
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-05-01
Last Update Date:2024-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty