MEDICARE: EKAETTE UDOH

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2355S0801X	Speech-Language Assistant	40641	TX
2	235Z00000X	Speech-Language Pathologist	40641	TX

General Provider Information

NPI Number	:	1538635388
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EKAETTE UDOH

Provider Business Mailing Address
First Line	:	8719 ROCKY VALLEY DR
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77083-5660
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	8719 ROCKY VALLEY DR
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77083-5660
Country	:	US
Telephone Number	:	832-814-6740
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/19/2018
Last Update Date	:	10/19/2018

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Directions to “ EKAETTE UDOH ” Practice Location

Language	Start Address	Practice Location

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