Provider Demographics
NPI:1881330033
Name:FAULKNER, MARITZA NICOLE (MS CCC-SLP)
Entity type:Individual
Prefix:
First Name:MARITZA
Middle Name:NICOLE
Last Name:FAULKNER
Suffix:
Gender:F
Credentials:MS CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9701 ALMEDA GENOA RD BLDG F
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77075-2411
Mailing Address - Country:US
Mailing Address - Phone:832-331-2460
Mailing Address - Fax:
Practice Address - Street 1:9701 ALMEDA GENOA RD BLDG F
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77075-2411
Practice Address - Country:US
Practice Address - Phone:832-331-2460
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-05-10
Last Update Date:2022-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX104564235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX386603001Medicaid