Provider Demographics
NPI:1295024701
Name:GREENE, KAI JASON (CCC SLP # 12045275)
Entity type:Individual
Prefix:
First Name:KAI
Middle Name:JASON
Last Name:GREENE
Suffix:
Gender:M
Credentials:CCC SLP # 12045275
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Mailing Address - Street 1:1UNIVERSITY STATION A1100, CMS 2.200
Mailing Address - Street 2:1UNIVERSITY STATION A1100, CMS 2.200
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78712
Mailing Address - Country:US
Mailing Address - Phone:512-471-3841
Mailing Address - Fax:512-232-1804
Practice Address - Street 1:2504 A WHITIS, CMA 2.200
Practice Address - Street 2:2504 A WHITIS, CMA 2.200
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78712
Practice Address - Country:US
Practice Address - Phone:512-471-3841
Practice Address - Fax:512-232-1804
Is Sole Proprietor?:No
Enumeration Date:2011-04-05
Last Update Date:2011-04-05
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXTSHA # 29200235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist