MEDICARE: MS. KISA JEANNETTE BRACEY MED,CCC-SLP

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	235Z00000X	Speech-Language Pathologist	19459	TX

General Provider Information

NPI Number	:	1568584647
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. KISA JEANNETTE BRACEY MED,CCC-SLP

Provider Business Mailing Address
First Line	:	2336 SHALLOW CREEK LN
Second Line	:
City	:	FRIENDSWOOD
State	:	TX
Zip	:	77546-1506
Country	:	US
Telephone Number	:	832-769-3122
Fax Number	:	713-436-2587

Provider Business Practice Location Address
First Line	:	2045 SPACE PARK DR STE 140
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77058-6305
Country	:	US
Telephone Number	:	832-769-3122
Fax Number	:	713-965-9921

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

Provider Enumeration Date	:	04/06/2007
Last Update Date	:	09/25/2025

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