Provider Demographics
NPI:1437986163
Name:CAIN, ETHAN V
Entity type:Individual
Prefix:
First Name:ETHAN
Middle Name:V
Last Name:CAIN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14409 SERRANO RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:HASLET
Mailing Address - State:TX
Mailing Address - Zip Code:76052-5855
Mailing Address - Country:US
Mailing Address - Phone:254-654-9168
Mailing Address - Fax:
Practice Address - Street 1:14409 SERRANO RIDGE RD
Practice Address - Street 2:
Practice Address - City:HASLET
Practice Address - State:TX
Practice Address - Zip Code:76052-5855
Practice Address - Country:US
Practice Address - Phone:254-654-9168
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-17
Last Update Date:2024-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX438822355S0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant