Provider Demographics
NPI:1851487136
Name:LISTI, PATRICIA M (MCD CCC A)
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:M
Last Name:LISTI
Suffix:
Gender:F
Credentials:MCD CCC A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21715 KINGSLAND BLVD STE 105
Mailing Address - Street 2:
Mailing Address - City:KATY
Mailing Address - State:TX
Mailing Address - Zip Code:77450-2544
Mailing Address - Country:US
Mailing Address - Phone:281-578-7500
Mailing Address - Fax:281-492-9204
Practice Address - Street 1:21715 KINGSLAND BLVD STE 105
Practice Address - Street 2:
Practice Address - City:KATY
Practice Address - State:TX
Practice Address - Zip Code:77450-2544
Practice Address - Country:US
Practice Address - Phone:281-578-7500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-05
Last Update Date:2018-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX51370231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS302I644034Medicare PIN