Provider Demographics
NPI:1659800399
Name:KLEINE, ETHAN RAY (CF-SLP)
Entity Type:Individual
Prefix:
First Name:ETHAN
Middle Name:RAY
Last Name:KLEINE
Suffix:
Gender:M
Credentials:CF-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10806 ALMEDA PARK DR
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77045-3540
Mailing Address - Country:US
Mailing Address - Phone:979-417-7071
Mailing Address - Fax:
Practice Address - Street 1:9990 RICHMOND AVE # 201-S
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77042-4559
Practice Address - Country:US
Practice Address - Phone:713-783-8181
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-07
Last Update Date:2017-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist