Provider Demographics
NPI:1255757159
Name:SPILLER, MAURA (CCC-SLP)
Entity type:Individual
Prefix:
First Name:MAURA
Middle Name:
Last Name:SPILLER
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5434 MERCEDES AVE
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75206-5820
Mailing Address - Country:US
Mailing Address - Phone:214-533-0856
Mailing Address - Fax:
Practice Address - Street 1:5434 MERCEDES AVE
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75206-5820
Practice Address - Country:US
Practice Address - Phone:214-533-0856
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-03-15
Last Update Date:2014-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX105077235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist