Provider Demographics
NPI:1689119042
Name:UNIVERSITY OF HOUSTON
Entity Type:Organization
Organization Name:UNIVERSITY OF HOUSTON
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ASSOCIATE PROFESSOR
Authorized Official - Prefix:DR
Authorized Official - First Name:KIA
Authorized Official - Middle Name:NOELLE
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:PHD, CCC-SLP
Authorized Official - Phone:713-743-6777
Mailing Address - Street 1:4455 CULLEN BLVD
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77204-6018
Mailing Address - Country:US
Mailing Address - Phone:713-743-6777
Mailing Address - Fax:
Practice Address - Street 1:4455 CULLEN BLVD
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77204-6018
Practice Address - Country:US
Practice Address - Phone:713-743-6777
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-12-21
Last Update Date:2016-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX112061235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty