Provider Demographics
NPI:1912120197
Name:SOILEAU, KRISTI HIGHTOWER (MS, CCC-A-SLP)
Entity Type:Individual
Prefix:
First Name:KRISTI
Middle Name:HIGHTOWER
Last Name:SOILEAU
Suffix:
Gender:F
Credentials:MS, CCC-A-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3195 CALDER ST STE 201
Mailing Address - Street 2:
Mailing Address - City:BEAUMONT
Mailing Address - State:TX
Mailing Address - Zip Code:77702-1426
Mailing Address - Country:US
Mailing Address - Phone:409-833-4115
Mailing Address - Fax:409-833-1626
Practice Address - Street 1:3195 CALDER ST STE 201
Practice Address - Street 2:
Practice Address - City:BEAUMONT
Practice Address - State:TX
Practice Address - Zip Code:77702-1426
Practice Address - Country:US
Practice Address - Phone:409-833-4115
Practice Address - Fax:409-833-1626
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-10
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX51296235500000X
235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
No235500000XSpeech, Language and Hearing Service ProvidersSpecialist/Technologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX089419801Medicaid
TX8T3319OtherBC-BS INSURANCE