Provider Demographics
NPI:1568604684
Name:MEHTA, KETKI (SLP)
Entity Type:Individual
Prefix:
First Name:KETKI
Middle Name:
Last Name:MEHTA
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15511 STABLE LAKE DR
Mailing Address - Street 2:
Mailing Address - City:CYPRESS
Mailing Address - State:TX
Mailing Address - Zip Code:77429-7088
Mailing Address - Country:US
Mailing Address - Phone:281-351-9933
Mailing Address - Fax:
Practice Address - Street 1:15511 STABLE LAKE DR
Practice Address - Street 2:
Practice Address - City:CYPRESS
Practice Address - State:TX
Practice Address - Zip Code:77429-7088
Practice Address - Country:US
Practice Address - Phone:281-351-9933
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-03
Last Update Date:2009-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX13887235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX13887OtherSPEECH LANGUAGE PATHOLOGY LICENSES