Provider Demographics
NPI:1104554690
Name:DOCKENS, KRYSTI K
Entity type:Individual
Prefix:
First Name:KRYSTI
Middle Name:K
Last Name:DOCKENS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:695 WOODROW ST
Mailing Address - Street 2:
Mailing Address - City:SILSBEE
Mailing Address - State:TX
Mailing Address - Zip Code:77656-5437
Mailing Address - Country:US
Mailing Address - Phone:409-980-7844
Mailing Address - Fax:
Practice Address - Street 1:695 WOODROW ST
Practice Address - Street 2:
Practice Address - City:SILSBEE
Practice Address - State:TX
Practice Address - Zip Code:77656-5437
Practice Address - Country:US
Practice Address - Phone:409-980-7844
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-11
Last Update Date:2022-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX16845235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist