Provider Demographics
NPI:1205248408
Name:BRONSON, KAITING
Entity type:Individual
Prefix:
First Name:KAITING
Middle Name:
Last Name:BRONSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6000 SHEPHERD MOUNTAIN CV UNIT 1004
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78730-4904
Mailing Address - Country:US
Mailing Address - Phone:737-888-1024
Mailing Address - Fax:512-233-0693
Practice Address - Street 1:16800 ENNIS TRL
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78717-5506
Practice Address - Country:US
Practice Address - Phone:737-888-1024
Practice Address - Fax:512-233-0693
Is Sole Proprietor?:No
Enumeration Date:2014-05-22
Last Update Date:2017-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX111760235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist