Provider Demographics
NPI:1184044711
Name:KNISS, CAROLYN (MA)
Entity Type:Individual
Prefix:MRS
First Name:CAROLYN
Middle Name:
Last Name:KNISS
Suffix:
Gender:F
Credentials:MA
Other - Prefix:MISS
Other - First Name:CAROLYN
Other - Middle Name:
Other - Last Name:RHOADS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA
Mailing Address - Street 1:4250 COOK RD
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77072-1115
Mailing Address - Country:US
Mailing Address - Phone:281-498-8110
Mailing Address - Fax:
Practice Address - Street 1:4250 COOK RD
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77072-1115
Practice Address - Country:US
Practice Address - Phone:281-498-8110
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-04-22
Last Update Date:2022-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX18650235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0657199-01Medicaid