Provider Demographics
NPI:1174668529
Name:BOLLING, KENYETTA LASYL (MS, CCC-SLP)
Entity Type:Individual
Prefix:MS
First Name:KENYETTA
Middle Name:LASYL
Last Name:BOLLING
Suffix:
Gender:F
Credentials:MS, CCC-SLP
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Mailing Address - Street 1:2815 AKUMAL LN
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77073-2912
Mailing Address - Country:US
Mailing Address - Phone:281-821-6741
Mailing Address - Fax:281-449-4886
Practice Address - Street 1:7000 NW 100 DR # B100
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77092-2051
Practice Address - Country:US
Practice Address - Phone:713-462-6060
Practice Address - Fax:866-849-5747
Is Sole Proprietor?:No
Enumeration Date:2007-02-21
Last Update Date:2018-10-15
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TX19807235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist