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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