Individual
TRYSTAN MICAH HENNESSY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
6502 SLIDE RD STE 204, LUBBOCK, TX 79424-1311
(806) 686-0429
Mailing address
5509 50TH ST APT 1205, LUBBOCK, TX 79414-1624
(575) 309-1168
Taxonomy
Speciality
Code
Description
License number
State
2355S0801X
Speech-Language Assistant
Primary
—
—
Other
Enumeration date
11/06/2023
Last updated
11/06/2023
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