Provider Demographics
NPI:1518203983
Name:LESNIEWICZ, KIMBERLY SHAUN (MA, CCC-SLP, CBIS)
Entity Type:Individual
Prefix:MS
First Name:KIMBERLY
Middle Name:SHAUN
Last Name:LESNIEWICZ
Suffix:
Gender:F
Credentials:MA, CCC-SLP, CBIS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11002 CRESTMORE ST
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77096-6120
Mailing Address - Country:US
Mailing Address - Phone:832-814-1384
Mailing Address - Fax:
Practice Address - Street 1:11002 CRESTMORE ST
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77096-6120
Practice Address - Country:US
Practice Address - Phone:832-814-1384
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-12-12
Last Update Date:2020-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX24941235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist