Provider Demographics
NPI:1417095647
Name:KIENHOLZ, BARRY QUENTIN (MA)
Entity Type:Individual
Prefix:MR
First Name:BARRY
Middle Name:QUENTIN
Last Name:KIENHOLZ
Suffix:
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 8036
Mailing Address - Street 2:
Mailing Address - City:THE WOODLANDS
Mailing Address - State:TX
Mailing Address - Zip Code:77387-8036
Mailing Address - Country:US
Mailing Address - Phone:281-363-2847
Mailing Address - Fax:281-298-2782
Practice Address - Street 1:19221 IH 45 S.
Practice Address - Street 2:#140
Practice Address - City:CONROE
Practice Address - State:TX
Practice Address - Zip Code:77385
Practice Address - Country:US
Practice Address - Phone:281-363-2847
Practice Address - Fax:281-298-2782
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX50414237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX530804OtherBLUE CROSS BLUE SHIELD