Provider Demographics
NPI:1154929792
Name:ROEMER, KIRSIE HEATHER (CCC-SLP)
Entity type:Individual
Prefix:
First Name:KIRSIE
Middle Name:HEATHER
Last Name:ROEMER
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:KIRSIE
Other - Middle Name:HEATHER
Other - Last Name:AHO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CCC-SLP
Mailing Address - Street 1:100 WALTER STEPHENSON RD
Mailing Address - Street 2:
Mailing Address - City:MIDLOTHIAN
Mailing Address - State:TX
Mailing Address - Zip Code:76065-3418
Mailing Address - Country:US
Mailing Address - Phone:469-856-6000
Mailing Address - Fax:
Practice Address - Street 1:600 S 5TH ST
Practice Address - Street 2:
Practice Address - City:MIDLOTHIAN
Practice Address - State:TX
Practice Address - Zip Code:76065-3425
Practice Address - Country:US
Practice Address - Phone:469-856-6000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-15
Last Update Date:2022-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX117949235Z00000X
MN10297235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX446065101Medicaid