Provider Demographics
NPI:1295172393
Name:IDENTIFY ASSESS AND TREAT SPEECH AND LANGUAGE SERVICES
Entity type:Organization
Organization Name:IDENTIFY ASSESS AND TREAT SPEECH AND LANGUAGE SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SPEECH LANGUAGE PATHOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:KASHONDA
Authorized Official - Middle Name:
Authorized Official - Last Name:BOWIE-CLOPHUS
Authorized Official - Suffix:
Authorized Official - Credentials:CCC-SLP
Authorized Official - Phone:713-870-9626
Mailing Address - Street 1:13930 SUTTON GLEN LN
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77047-7544
Mailing Address - Country:US
Mailing Address - Phone:713-283-1753
Mailing Address - Fax:
Practice Address - Street 1:13930 SUTTON GLEN LN
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77047-7544
Practice Address - Country:US
Practice Address - Phone:713-283-1753
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-05-29
Last Update Date:2013-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX105347235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty