Provider Demographics
NPI:1952636482
Name:KTENIDIS, HEATHER MARINA
Entity Type:Individual
Prefix:MS
First Name:HEATHER
Middle Name:MARINA
Last Name:KTENIDIS
Suffix:
Gender:F
Credentials:
Other - Prefix:MISS
Other - First Name:HEATHER
Other - Middle Name:MARINA
Other - Last Name:SLIMON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RD, LD
Mailing Address - Street 1:24046 HIGHWAY 59 N
Mailing Address - Street 2:
Mailing Address - City:KINGWOOD
Mailing Address - State:TX
Mailing Address - Zip Code:77339-1500
Mailing Address - Country:US
Mailing Address - Phone:281-358-3387
Mailing Address - Fax:281-312-4445
Practice Address - Street 1:2002 TIMBERLOCH PL
Practice Address - Street 2:STE 200
Practice Address - City:THE WOODLANDS
Practice Address - State:TX
Practice Address - Zip Code:77380-1182
Practice Address - Country:US
Practice Address - Phone:281-989-0453
Practice Address - Fax:866-649-8471
Is Sole Proprietor?:No
Enumeration Date:2009-10-16
Last Update Date:2017-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXDT80166133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered