Provider Demographics
NPI:1316451198
Name:SAENZ, MICHAEL KING (PHD, MA, CCC-SLP)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:KING
Last Name:SAENZ
Suffix:
Gender:M
Credentials:PHD, MA, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2024 CLOVER LN
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76107-3909
Mailing Address - Country:US
Mailing Address - Phone:817-874-8084
Mailing Address - Fax:
Practice Address - Street 1:2024 CLOVER LN
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76107-3909
Practice Address - Country:US
Practice Address - Phone:817-874-8084
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-11-30
Last Update Date:2017-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX102311235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist