Basic Information
| Provider Information | |||||||||
| NPI: | 1154632156 | ||||||||
| EntityType: | 1 | ||||||||
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| LastName: | VAN VUREN | ||||||||
| FirstName: | CAYLA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 411 STARS DR | ||||||||
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| City: | ANNA | ||||||||
| State: | TX | ||||||||
| PostalCode: | 754095451 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 9900 N CENTRAL EXPY | ||||||||
| Address2: | SUITE 300 | ||||||||
| City: | DALLAS | ||||||||
| State: | TX | ||||||||
| PostalCode: | 752314395 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2142650420 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/24/2010 | ||||||||
| LastUpdateDate: | 04/07/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 04/07/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2355S0801X | 35537 | TX | N | Speech, Language and Hearing Service Providers | Specialist/Technologist | Speech-Language Assistant | 235Z00000X | 110999 | TX | Y | Speech, Language and Hearing Service Providers | Speech-Language Pathologist |
ID Information
| ID | Type | State | Issuer | Description | 149984001 | 05 | TX | MEDICAID |