Provider Demographics
NPI:1710608435
Name:STONEHAM, KATHRYN TRENT
Entity Type:Individual
Prefix:
First Name:KATHRYN
Middle Name:TRENT
Last Name:STONEHAM
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18506 INSPIRATION DR
Mailing Address - Street 2:
Mailing Address - City:CYPRESS
Mailing Address - State:TX
Mailing Address - Zip Code:77433-8088
Mailing Address - Country:US
Mailing Address - Phone:713-416-8202
Mailing Address - Fax:
Practice Address - Street 1:10607 MASON RD
Practice Address - Street 2:
Practice Address - City:CYPRESS
Practice Address - State:TX
Practice Address - Zip Code:77433-7097
Practice Address - Country:US
Practice Address - Phone:832-349-7400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-09
Last Update Date:2022-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX19030235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1609917541Medicaid