Provider Demographics
NPI:1790098994
Name:MOUTON, KATHERINE E (CCC-SLP)
Entity Type:Individual
Prefix:
First Name:KATHERINE
Middle Name:E
Last Name:MOUTON
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1544 SAWDUST RD
Mailing Address - Street 2:SUITE 105
Mailing Address - City:THE WOODLANDS
Mailing Address - State:TX
Mailing Address - Zip Code:77380-2929
Mailing Address - Country:US
Mailing Address - Phone:832-738-0507
Mailing Address - Fax:
Practice Address - Street 1:1544 SAWDUST RD
Practice Address - Street 2:SUITE 105
Practice Address - City:THE WOODLANDS
Practice Address - State:TX
Practice Address - Zip Code:77380-2929
Practice Address - Country:US
Practice Address - Phone:832-738-0507
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-16
Last Update Date:2012-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX105131235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist