MEDICARE: KEISHA FONTE THOMPSON

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

General Provider Information

NPI Number	:	1639908908
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KEISHA FONTE THOMPSON

Provider Business Mailing Address
First Line	:	1717 W 34TH ST STE 600
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77018-6264
Country	:	US
Telephone Number	:	678-822-8839
Fax Number	:

Provider Business Practice Location Address
First Line	:	1717 W 34TH ST STE 600
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77018-6264
Country	:	US
Telephone Number	:	678-822-8839
Fax Number	:

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

Provider Enumeration Date	:	07/26/2024
Last Update Date	:	07/26/2024

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Directions to “ KEISHA FONTE THOMPSON ” Practice Location

Language	Start Address	Practice Location

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