Provider Demographics
NPI:1518926104
Name:MARQUARDT, KIMLEY SHEA (MS, CCC-A)
Entity Type:Individual
Prefix:MRS
First Name:KIMLEY
Middle Name:SHEA
Last Name:MARQUARDT
Suffix:
Gender:F
Credentials:MS, CCC-A
Other - Prefix:
Other - First Name:KIMLEY
Other - Middle Name:SHEA
Other - Last Name:SMITH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, CCC-A
Mailing Address - Street 1:10740 N GESSNER DR
Mailing Address - Street 2:STE 310
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77064-1240
Mailing Address - Country:US
Mailing Address - Phone:281-897-0416
Mailing Address - Fax:281-890-8908
Practice Address - Street 1:17070 RED OAK DR
Practice Address - Street 2:STE 205
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77090-2615
Practice Address - Country:US
Practice Address - Phone:281-440-0734
Practice Address - Fax:281-440-8065
Is Sole Proprietor?:No
Enumeration Date:2006-03-22
Last Update Date:2010-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX51421231H00000X, 237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
No237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8L12357Medicare PIN
TX8L12356Medicare PIN