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Organization
OLIVE BRANCH AUTISM CLINIC AND THERAPY SERVICES LLC
Active
Organization
OLIVE BRANCH AUTISM CLINIC AND THERAPY SERVICES LLC
Active
Other names
Olive Branch Therapy
Organization subpart
No
Provider details
NPI number
Authorized official
SHAWNA MARIE NICKERSON M.A., CCC-SLP (SPEECH LANGUAGE PATHOLOGIST)
(770) 630-6753
Entity
Organization
Contact information
Practice address
2526 KINSGATE FOREST DR, KATY, TX 77494-1898
(832) 557-0579
(832) 553-7719
Mailing address
2526 KINSGATE FOREST DR, KATY, TX 77494-1898
(770) 630-6753
(832) 553-7719
Taxonomy
Speciality
Code
Description
License number
State
261QH0700X
Hearing and Speech Clinic/Center
Primary
108185
TX
Other
Enumeration date
03/01/2018
Last updated
03/08/2019
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