Basic Information
| Provider Information | |||||||||
| NPI: | 1144576521 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | RODGERS | ||||||||
| FirstName: | KISI | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1240 BLALOCK RD STE 170 | ||||||||
| Address2: | |||||||||
| City: | HOUSTON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 770556447 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7134680300 | ||||||||
| FaxNumber: | 7134680336 | ||||||||
| Practice Location | |||||||||
| Address1: | 1240 BLALOCK RD STE 170 | ||||||||
| Address2: | |||||||||
| City: | HOUSTON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 770556447 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7134680300 | ||||||||
| FaxNumber: | 7134680336 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/03/2012 | ||||||||
| LastUpdateDate: | 08/03/2012 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 235Z00000X | 106953 | TX | Y | Speech, Language and Hearing Service Providers | Speech-Language Pathologist |
No ID Information.