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

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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