Provider Demographics
NPI:1568584647
Name:BRACEY, KISA JEANNETTE (MED,CCC-SLP)
Entity Type:Individual
Prefix:MS
First Name:KISA
Middle Name:JEANNETTE
Last Name:BRACEY
Suffix:
Gender:F
Credentials:MED,CCC-SLP
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:2725 HIDDEN LANDING DR
Mailing Address - Street 2:
Mailing Address - City:PEARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:77584-8788
Mailing Address - Country:US
Mailing Address - Phone:713-426-2587
Mailing Address - Fax:713-436-2587
Practice Address - Street 1:3040 POST OAK BLVD
Practice Address - Street 2:SUITE 1200
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77056-6500
Practice Address - Country:US
Practice Address - Phone:713-965-9998
Practice Address - Fax:713-965-9921
Is Sole Proprietor?:No
Enumeration Date:2007-04-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX19459235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist