Healthcare Provider Details

I. General information

NPI: 1548492119
Provider Name (Legal Business Name): MISHA NICOLE KINKADE M.S./ CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/17/2009
Last Update Date: 08/17/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2401 S WILLIS ST STE 100
ABILENE TX
79605-6254
US

IV. Provider business mailing address

3101 BROKEN BOUGH TRL
ABILENE TX
79606-3572
US

V. Phone/Fax

Practice location:
  • Phone: 325-692-9700
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number101461
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: