Provider Demographics
NPI:1104119502
Name:MARTIN, KRISTEN MICHELLE (MS CCC/SLP)
Entity type:Individual
Prefix:MRS
First Name:KRISTEN
Middle Name:MICHELLE
Last Name:MARTIN
Suffix:
Gender:F
Credentials:MS CCC/SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3909 CEDAR RIDGE LN
Mailing Address - Street 2:
Mailing Address - City:CARROLLTON
Mailing Address - State:TX
Mailing Address - Zip Code:75007-1119
Mailing Address - Country:US
Mailing Address - Phone:214-683-7650
Mailing Address - Fax:
Practice Address - Street 1:3909 CEDAR RIDGE LN
Practice Address - Street 2:
Practice Address - City:CARROLLTON
Practice Address - State:TX
Practice Address - Zip Code:75007-1119
Practice Address - Country:US
Practice Address - Phone:214-683-7650
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-18
Last Update Date:2011-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX17546235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist