Provider Demographics
NPI:1841928124
Name:SIDDIQUI, MARIAM
Entity type:Individual
Prefix:
First Name:MARIAM
Middle Name:
Last Name:SIDDIQUI
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 1:19106 GOLDEN HEATH LN
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:TX
Mailing Address - Zip Code:77407-3818
Mailing Address - Country:US
Mailing Address - Phone:832-366-1855
Mailing Address - Fax:
Practice Address - Street 1:19106 GOLDEN HEATH LN
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:TX
Practice Address - Zip Code:77407-3818
Practice Address - Country:US
Practice Address - Phone:832-366-1855
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-12
Last Update Date:2022-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX118872235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist