Provider Demographics
NPI:1801082888
Name:HATHWAY, JEREMY R (CCC-SLP)
Entity type:Individual
Prefix:MR
First Name:JEREMY
Middle Name:R
Last Name:HATHWAY
Suffix:
Gender:M
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6550 FANNIN ST
Mailing Address - Street 2:SUITE 2025
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77030-2717
Mailing Address - Country:US
Mailing Address - Phone:713-796-2181
Mailing Address - Fax:713-796-2349
Practice Address - Street 1:6550 FANNIN ST
Practice Address - Street 2:SUITE 2025
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77030-2717
Practice Address - Country:US
Practice Address - Phone:713-796-2181
Practice Address - Fax:713-796-2349
Is Sole Proprietor?:No
Enumeration Date:2007-09-24
Last Update Date:2012-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX102640235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
12122455OtherASHA ID