Basic Information
Provider Information
NPI: 1063030823
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: PARISH
FirstName: LUCY
MiddleName: A
NamePrefix:  
NameSuffix:  
Credential:  
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
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OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 3721 EXECUTIVE CENTER DR STE 201
Address2:  
City: AUSTIN
State: TX
PostalCode: 787311639
CountryCode: US
TelephoneNumber: 5123723777
FaxNumber:  
Practice Location
Address1: 9616 N LAMAR BLVD STE 105
Address2:  
City: AUSTIN
State: TX
PostalCode: 787534163
CountryCode: US
TelephoneNumber: 5125279608
FaxNumber:  
Other Information
ProviderEnumerationDate: 07/08/2020
LastUpdateDate: 07/08/2020
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
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AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: Y
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 07/08/2020

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
235Z00000X TXY193400000X SINGLE SPECIALTY GROUPSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist 

No ID Information.


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