MEDICARE: ANDREA KONG M.S.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	121681	TX

General Provider Information

NPI Number	:	1154164267
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANDREA KONG M.S.CCC-SLP

Provider Business Mailing Address
First Line	:	12625 MEMORIAL DR APT 145
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77024-4878
Country	:	US
Telephone Number	:	713-469-1435
Fax Number	:

Provider Business Practice Location Address
First Line	:	2990 RICHMOND AVE STE 180
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77098-3116
Country	:	US
Telephone Number	:	281-829-0103
Fax Number	:

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

Provider Enumeration Date	:	06/17/2024
Last Update Date	:	06/17/2024

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Directions to “ ANDREA KONG M.S.CCC-SLP” Practice Location

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