Provider Demographics
NPI:1528547015
Name:HERRINGTON, KACIE L (MS SLP-INTERN)
Entity type:Individual
Prefix:
First Name:KACIE
Middle Name:L
Last Name:HERRINGTON
Suffix:
Gender:F
Credentials:MS SLP-INTERN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11488 STUART ST
Mailing Address - Street 2:
Mailing Address - City:BROWNSBORO
Mailing Address - State:TX
Mailing Address - Zip Code:75756-6107
Mailing Address - Country:US
Mailing Address - Phone:254-978-0430
Mailing Address - Fax:
Practice Address - Street 1:100 E FERGUSON ST STE 1204
Practice Address - Street 2:
Practice Address - City:TYLER
Practice Address - State:TX
Practice Address - Zip Code:75702-5700
Practice Address - Country:US
Practice Address - Phone:877-688-2520
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-07
Last Update Date:2022-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX119525235Z00000X
TX404352355S0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
No2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant