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Organization
SPEECH DIVAS
Active
Organization
SPEECH DIVAS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KATHY ANN PARK M.S., CCC-SLP (SPEECH-LANGUAGE PATHOLOGIST)
(817) 371-3353
Entity
Organization
Contact information
Practice address
4229 PERIWINKLE DR, FORT WORTH, TX 76137-3013
(469) 834-5742
Mailing address
4229 PERIWINKLE DR, FORT WORTH, TX 76137-3013
(469) 834-5742
Taxonomy
Speciality
Code
Description
License number
State
2355S0801X
Speech-Language Assistant
33891
TX
235Z00000X
Speech-Language Pathologist
Primary
19126
TX
Other
Enumeration date
06/03/2012
Last updated
06/03/2012
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