MEDICARE: KRISSHONDA ELAINE ODUFUWA M.E.D, SLPA, BCBA

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	103K00000X	Behavior Analyst	1958	TX
2	2355S0801X	Speech-Language Assistant	35492	TX

General Provider Information

NPI Number	:	1720480064
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KRISSHONDA ELAINE ODUFUWA M.E.D, SLPA, BCBA

Provider Business Mailing Address
First Line	:	4424 RUSTIC RIDGE DR
Second Line	:
City	:	MCKINNEY
State	:	TX
Zip	:	75071-5453
Country	:	US
Telephone Number	:	832-613-4417
Fax Number	:

Provider Business Practice Location Address
First Line	:	4424 RUSTIC RIDGE DR
Second Line	:
City	:	MCKINNEY
State	:	TX
Zip	:	75071-5453
Country	:	US
Telephone Number	:	832-613-4417
Fax Number	:

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

Provider Enumeration Date	:	09/18/2014
Last Update Date	:	01/12/2026

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