Provider Demographics
NPI:1407097694
Name:HOUSTON, KEVIN TODD (PHD)
Entity Type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:TODD
Last Name:HOUSTON
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1000 OLD MAIN HL
Mailing Address - Street 2:UTAH STATE UNIVERSITY
Mailing Address - City:LOGAN
Mailing Address - State:UT
Mailing Address - Zip Code:84322-1000
Mailing Address - Country:US
Mailing Address - Phone:435-797-0434
Mailing Address - Fax:435-797-0221
Practice Address - Street 1:1000 OLD MAIN HL
Practice Address - Street 2:UTAH STATE UNIVERSITY
Practice Address - City:LOGAN
Practice Address - State:UT
Practice Address - Zip Code:84322-1000
Practice Address - Country:US
Practice Address - Phone:435-797-0434
Practice Address - Fax:435-797-0221
Is Sole Proprietor?:No
Enumeration Date:2009-03-17
Last Update Date:2009-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT6635704-4102235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist