Provider Demographics
NPI:1164746616
Name:NAKATA-HAMADA, KATHRYN KIYOMI
Entity Type:Individual
Prefix:
First Name:KATHRYN
Middle Name:KIYOMI
Last Name:NAKATA-HAMADA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11627 GALLANT RIDGE LN
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77082-6834
Mailing Address - Country:US
Mailing Address - Phone:281-496-4355
Mailing Address - Fax:
Practice Address - Street 1:11001 HAMMERLY BLVD
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77043-1913
Practice Address - Country:US
Practice Address - Phone:713-467-4696
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-25
Last Update Date:2010-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX105638235Z00000X
CA8867235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist