MEDICARE: KJB SPEECH THERAPY PLLC

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	:	1871158253
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KJB SPEECH THERAPY PLLC

Provider Business Mailing Address
First Line	:	2336 SHALLOW CREEK LN
Second Line	:
City	:	FRIENDSWOOD
State	:	TX
Zip	:	77546-1506
Country	:	US
Telephone Number	:	832-769-3122
Fax Number	:

Provider Business Practice Location Address
First Line	:	2045 SPACE PARK DR STE 140
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77058-6305
Country	:	US
Telephone Number	:	832-769-3122
Fax Number	:	832-769-3059

Authorized Official
Title or Position	:	OWNER/LEAD THERAPIST
Name	:	KISA JEANNETTE BRACEY
Credential	:	CCC-SLP
Telephone Number	:	832-217-9410

Provider Enumeration Date	:	05/01/2019
Last Update Date	:	09/25/2025

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