Provider Demographics
NPI:1659712792
Name:CUMMINGS-BOULTE, KATHY L (MS, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:KATHY
Middle Name:L
Last Name:CUMMINGS-BOULTE
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1216 CHANTILLY LN
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77018-3115
Mailing Address - Country:US
Mailing Address - Phone:281-610-3314
Mailing Address - Fax:
Practice Address - Street 1:1216 CHANTILLY LN
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77018-3115
Practice Address - Country:US
Practice Address - Phone:281-610-3314
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-07-16
Last Update Date:2013-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX105183235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist