Healthcare Provider Details

I. General information

NPI: 1871158253
Provider Name (Legal Business Name): KJB SPEECH THERAPY PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/01/2019
Last Update Date: 09/25/2025
Certification Date: 09/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2045 SPACE PARK DR STE 140
HOUSTON TX
77058-6305
US

IV. Provider business mailing address

2336 SHALLOW CREEK LN
FRIENDSWOOD TX
77546-1506
US

V. Phone/Fax

Practice location:
  • Phone: 832-769-3122
  • Fax: 832-769-3059
Mailing address:
  • Phone: 832-769-3122
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: KISA JEANNETTE BRACEY
Title or Position: OWNER/LEAD THERAPIST
Credential: CCC-SLP
Phone: 832-217-9410