Provider Demographics
NPI:1366470759
Name:KOLEN, ALICIA (SLP)
Entity Type:Individual
Prefix:
First Name:ALICIA
Middle Name:
Last Name:KOLEN
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1421 FM 359 RD STE H
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:TX
Mailing Address - Zip Code:77406-2023
Mailing Address - Country:US
Mailing Address - Phone:281-232-1900
Mailing Address - Fax:
Practice Address - Street 1:1421 FM 359 RD STE H
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:TX
Practice Address - Zip Code:77406-2023
Practice Address - Country:US
Practice Address - Phone:281-232-1900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-28
Last Update Date:2020-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR2063235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR5X564OtherBLUE CROSS BLUE SHIELD
AR150383721Medicaid