Provider Demographics
NPI:1720454465
Name:KLEMENT, NIATASHA (SLP)
Entity Type:Individual
Prefix:
First Name:NIATASHA
Middle Name:
Last Name:KLEMENT
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:PO BOX 1731
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:76241-1731
Mailing Address - Country:US
Mailing Address - Phone:940-736-7019
Mailing Address - Fax:
Practice Address - Street 1:1201 S LINDSAY ST
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:TX
Practice Address - Zip Code:76240-5661
Practice Address - Country:US
Practice Address - Phone:940-612-0730
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-08-17
Last Update Date:2022-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX110660235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist