Mary M. Augustine, M.S., CCC-SLP

Individual provider Active NPI Speech-Language Pathologist · Coppell, TX

NPI 1629201983 · NPPES record last updated May 25, 2021

Key facts

NPI
1629201983
Entity type
Individual (NPI type 1)
Primary specialty
Speech-Language Pathologist 235Z00000X
License
103453 (TX)
Practice address
580 S Denton Tap Rd Ste 270
Coppell, TX 75019-4094
Phone
(469) 763-9459
NPI assigned
Sep 2, 2009
Sex
Female
Sole proprietor
No

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Medicare participation

Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD)
No
Credentials
Master of Science

Practice roles

OrganizationSpecialtyStatusNew patients
Texas Tech University Health Sciences Center Lubbock Past Accepting new patients
University of Texas at Dallas Speech-Language Pathologist Past
since Jun 3, 2012
Accepting new patients

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Speech-Language Pathologist 235Z00000X 103453 TX Yes

Addresses

Primary practice location

580 S Denton Tap Rd Ste 270
Coppell, TX 75019-4094

Mailing address

413 Stonebridge Cir
Allen, TX 75013-3012
Phone (214) 991-2059

Other providers in Coppell, TX

All providers in Coppell, TX · Speech-Language Pathologist in Texas

Sources for this page

Verify at the official NPI Registry.