Basic Information
| Provider Information | |||||||||
| NPI: | 1225305287 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | TANGIBLE DIFFERENCE LEARNING CENTER, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 7010 NW 100 DR | ||||||||
| Address2: | #A104 | ||||||||
| City: | HOUSTON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 770922052 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7134626060 | ||||||||
| FaxNumber: | 7134626066 | ||||||||
| Practice Location | |||||||||
| Address1: | 7010 NW 100 DR | ||||||||
| Address2: | #A104 | ||||||||
| City: | HOUSTON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 770922052 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7134626060 | ||||||||
| FaxNumber: | 7134626066 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/18/2011 | ||||||||
| LastUpdateDate: | 11/18/2011 | ||||||||
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| AuthorizedOfficialLastName: | NEAL | ||||||||
| AuthorizedOfficialFirstName: | KELI | ||||||||
| AuthorizedOfficialMiddleName: | ROD | ||||||||
| AuthorizedOfficialTitleorPosition: | SPEECH LANGUAGE PATHOLOGIST | ||||||||
| AuthorizedOfficialTelephone: | 4097815855 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | SLP | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 235Z00000X | Y | 193200000X MULTI-SPECIALTY GROUP | Speech, Language and Hearing Service Providers | Speech-Language Pathologist |
No ID Information.