Provider Demographics
NPI:1164993374
Name:MOOMAU, KATIE KEANE (MS CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:KATIE
Middle Name:KEANE
Last Name:MOOMAU
Suffix:
Gender:F
Credentials:MS CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3042 PECAN POINT DR
Mailing Address - Street 2:
Mailing Address - City:SUGAR LAND
Mailing Address - State:TX
Mailing Address - Zip Code:77478-4225
Mailing Address - Country:US
Mailing Address - Phone:817-312-1958
Mailing Address - Fax:
Practice Address - Street 1:7002 RIVERBROOK DR STE 500
Practice Address - Street 2:
Practice Address - City:SUGAR LAND
Practice Address - State:TX
Practice Address - Zip Code:77479-6589
Practice Address - Country:US
Practice Address - Phone:281-343-7125
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-12-16
Last Update Date:2018-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX113971235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist