Provider Demographics
NPI:1942831771
Name:BAKARE, OMOTENIOLA AMINAT (SLP)
Entity Type:Individual
Prefix:
First Name:OMOTENIOLA
Middle Name:AMINAT
Last Name:BAKARE
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2600 GESSNER RD STE 190
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77080-3844
Mailing Address - Country:US
Mailing Address - Phone:713-996-7996
Mailing Address - Fax:
Practice Address - Street 1:2600 GESSNER RD STE 190
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77080-3844
Practice Address - Country:US
Practice Address - Phone:713-996-7996
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-01-30
Last Update Date:2020-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX115284235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist