Provider Demographics
NPI:1942507553
Name:TREVINO, KANDI LEA (MS, CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:KANDI
Middle Name:LEA
Last Name:TREVINO
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7213 TRAVELERS XING
Mailing Address - Street 2:
Mailing Address - City:ROWLETT
Mailing Address - State:TX
Mailing Address - Zip Code:75089-5127
Mailing Address - Country:US
Mailing Address - Phone:469-644-2005
Mailing Address - Fax:
Practice Address - Street 1:7213 TRAVELERS XING
Practice Address - Street 2:
Practice Address - City:ROWLETT
Practice Address - State:TX
Practice Address - Zip Code:75089-5127
Practice Address - Country:US
Practice Address - Phone:469-644-2005
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-02-16
Last Update Date:2011-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX18977235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist