Provider Demographics
NPI:1760615124
Name:ACHIEVE SPEECH AND LANGUAGE
Entity Type:Organization
Organization Name:ACHIEVE SPEECH AND LANGUAGE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SPEECH LANGUAGE PATHOLOGIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:KANDY
Authorized Official - Middle Name:
Authorized Official - Last Name:JENKS
Authorized Official - Suffix:
Authorized Official - Credentials:MS, CCC-SLP
Authorized Official - Phone:281-812-9519
Mailing Address - Street 1:19100 W LAKE HOUSTON PKWY
Mailing Address - Street 2:
Mailing Address - City:HUMBLE
Mailing Address - State:TX
Mailing Address - Zip Code:77346-5138
Mailing Address - Country:US
Mailing Address - Phone:281-812-9519
Mailing Address - Fax:281-812-5719
Practice Address - Street 1:19100 W LAKE HOUSTON PKWY
Practice Address - Street 2:
Practice Address - City:HUMBLE
Practice Address - State:TX
Practice Address - Zip Code:77346-5138
Practice Address - Country:US
Practice Address - Phone:281-812-9519
Practice Address - Fax:281-812-5719
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-09-01
Last Update Date:2009-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX104406261QH0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0700XAmbulatory Health Care FacilitiesClinic/CenterHearing and Speech