Provider Demographics
NPI:1538281902
Name:GREEN, KIMBERLY LARAE (MED,CCCC-SLP)
Entity Type:Individual
Prefix:MISS
First Name:KIMBERLY
Middle Name:LARAE
Last Name:GREEN
Suffix:
Gender:F
Credentials:MED,CCCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6000 REIMS RD
Mailing Address - Street 2:#2801
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77036-3006
Mailing Address - Country:US
Mailing Address - Phone:713-783-9969
Mailing Address - Fax:
Practice Address - Street 1:6109 MAPLE ST
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77074-7449
Practice Address - Country:US
Practice Address - Phone:713-668-6690
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX18921235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist