Healthcare Provider Details

I. General information

NPI: 1093624090
Provider Name (Legal Business Name): AUDREY LEBLANC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/04/2026
Last Update Date: 09/04/2026
Certification Date: 09/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6301 S STADIUM LN
KATY TX
77494-1057
US

IV. Provider business mailing address

3410 ARDENT OAK CIR
HOUSTON TX
77059-3774
US

V. Phone/Fax

Practice location:
  • Phone: 281-396-6000
  • Fax:
Mailing address:
  • Phone: 713-410-0296
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2355S0801X
TaxonomySpeech-Language Assistant
License Number45366
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: