Provider Demographics
NPI:1912549908
Name:SIEWOOD, KINDRA (SLP)
Entity Type:Individual
Prefix:MRS
First Name:KINDRA
Middle Name:
Last Name:SIEWOOD
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:MRS
Other - First Name:KINDRA
Other - Middle Name:
Other - Last Name:WOOD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:SLP
Mailing Address - Street 1:5811 DE LANGE LN
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77092-4107
Mailing Address - Country:US
Mailing Address - Phone:832-264-1596
Mailing Address - Fax:
Practice Address - Street 1:15320 TX-105 W
Practice Address - Street 2:SUITE 116
Practice Address - City:MONTGOMERY
Practice Address - State:TX
Practice Address - Zip Code:77356
Practice Address - Country:US
Practice Address - Phone:832-264-1596
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-11
Last Update Date:2019-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX111393235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist