Provider Demographics
NPI:1841947306
Name:BRISTER, KATELYN CHRISTINE
Entity type:Individual
Prefix:
First Name:KATELYN
Middle Name:CHRISTINE
Last Name:BRISTER
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 1:875 N ELDRIDGE PKWY APT 277
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77079-2731
Mailing Address - Country:US
Mailing Address - Phone:409-313-7442
Mailing Address - Fax:
Practice Address - Street 1:5905 S MASON RD
Practice Address - Street 2:
Practice Address - City:KATY
Practice Address - State:TX
Practice Address - Zip Code:77450-5461
Practice Address - Country:US
Practice Address - Phone:281-237-8850
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-04
Last Update Date:2022-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX113200235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty