Provider Demographics
NPI:1326500430
Name:REESE, KENNETH CONRAD (HIS)
Entity Type:Individual
Prefix:
First Name:KENNETH
Middle Name:CONRAD
Last Name:REESE
Suffix:
Gender:M
Credentials:HIS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1575 W GRAND PKWY S STE 900
Mailing Address - Street 2:
Mailing Address - City:KATY
Mailing Address - State:TX
Mailing Address - Zip Code:77494-8311
Mailing Address - Country:US
Mailing Address - Phone:832-437-6566
Mailing Address - Fax:832-437-9478
Practice Address - Street 1:1575 W GRAND PKWY S STE 900
Practice Address - Street 2:
Practice Address - City:KATY
Practice Address - State:TX
Practice Address - Zip Code:77494-8311
Practice Address - Country:US
Practice Address - Phone:832-437-6566
Practice Address - Fax:832-437-9478
Is Sole Proprietor?:No
Enumeration Date:2019-04-05
Last Update Date:2019-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX80835237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist