Provider Demographics
NPI:1881095768
Name:CORMIER, KELLY RENEE (AUD)
Entity type:Individual
Prefix:DR
First Name:KELLY
Middle Name:RENEE
Last Name:CORMIER
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:10740 N GESSNER DR.
Mailing Address - Street 2:STE 310
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77064-1240
Mailing Address - Country:US
Mailing Address - Phone:281-897-0416
Mailing Address - Fax:281-897-0416
Practice Address - Street 1:18400 KATY FWY
Practice Address - Street 2:STE. 470
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77094-1286
Practice Address - Country:US
Practice Address - Phone:281-492-7827
Practice Address - Fax:281-646-1416
Is Sole Proprietor?:No
Enumeration Date:2014-09-10
Last Update Date:2021-08-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CO728231H00000X
TX80908231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO381791YR4SMedicare PIN